Arkansas Hospitals Respond in Tornado’s Aftermath Providing Cancer Patients With

Arkansas Hospitals Respond in
Tornado’s Aftermath
Providing Cancer Patients With
“Hope Away From Home”
Action Ideas for Increasing
Staff Participation at Meetings
Arkansas Hospitals
is published by
Arkansas Hospital Association
419 Natural Resources Drive • Little Rock, AR 72205
501-224-7878 / FAX 501-224-0519
Beth H. Ingram, Editor
8 Hospitals Respond in Tornado’s Aftermath
12 Providing Cancer Patients with “Hope Away From Home”
28 Action Ideas for Increasing Staff Participation at Meetings
10 Thoughts on the President’s Budget Proposal
24 Working with Disruptive Board Members
26 Legal Note: Physician On-Call Coverage
Ray Montgomery, Searcy / Chairman
James Magee, Piggott / Chairman-elect
Luther Lewis, El Dorado / Treasurer
Robert Atkinson, Pine Bluff / Past-Chairman
Kirk Reamey, Ozark / At-Large
Jamie Carter, West Memphis
David Cicero, Camden
Les Frensley, Batesville
Pat Heinz, Little Rock
Tim Hill, Harrison
Ed Lacy, Heber Springs
Larry Morse, Clarksville
Doug Weeks, Little Rock
Russ Sword, Crossett
Phil E. Matthews / President and CEO
Robert “Bo” Ryall / Executive Vice President
W. Paul Cunningham / Senior Vice President
Elisa M. White / Vice President and General Counsel
Beth H. Ingram / Vice President
Don Adams / Vice President
Arkansas Hospitals is distributed quarterly
to hospital executives, managers, and trustees
throughout the United States; to physicians,
state legislators, the congressional delegation,
and other friends of the hospitals of Arkansas.
Governor Collects $2.2 Billion
Benchmarking to High Performers
Financial Challenges are Top CEO Concern
State Revises Death Certificate Form
ACH on 100 Best Workplace Listing
Wal-Mart, LR System Partner Up
Preventing Accidents and Injuries in the MRI
AHA Services Launches New Web Site
Hospital Executive/Trustee Leadership Conference
Call for 2008 Diamond Award Entries
Harding University Pharmacy Program
New OIG Advisory Opinions
Arkansas Hospital Utilization Moves Downward
AHA Will Intervene on PPA Matter
2008 Mid-Management Series Begins April 15
United Healthcare Revises Notification Policy
IRS Approves Revised 990, Schedule H
Look for Hospital Spending to Double by 2017
2008 HHS Federal Poverty Guidelines
Blue Cross Promotes Executives
2006 Health Spending Eases
Will Older Physicians Opt Out of Patient Care?
Arkansas PAC Contributions Recognized
Hospitals to Provide ACASA Materials
Many Labor-Related Resources Available
37 Arkansas Receives NDC Billing Extension
37 Community Match Physician Recruitment Program
38 A Look Back at 2007 Healthcare Legislation
39 FDA Recalls Contaminated Syringes
39 Arkansas Hospital Infection Committee Meets
39 Report Recommends Broadband Network
40 Trustees’ Responsibilities for Quality
41 Governor Appoints Healthcare Roundtable
41 Financial Incentive Program Guide
42 CMS Memo on Interpretive Guidelines
42 Proposed Rule for LTCHs
42 “Freestanding” Emergency Dept. Requirements
43 CMS Amends RAC Program Schedule
43 Arkansas Medicaid Outpatient Rate Update
43 Medicare Spending Tops $400 Billion
44 CMS Revamping Regional Offices
44 CAHs Allowed OPPS Reporting Participation
44 Guide for Medicare Code Editor
45 9th Statement of Work Changes QIOs’ Focus
46 Arkansas Medicaid Fixing EOB Problem
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Katrice Summerlin
Publishing Concepts, Inc.
[email protected]
Edition 62
46 Value Based Purchasing Report Issued
Cover Photo
Hot Springs
National Park
Photo courtesy of
Arkansas Dept.
of Parks and
From the President
Education Calendar
Arkansas Newsmakers and Newcomers
Spring 2008 I Arkansas Hospitals
Healthcare: Is it Time for a March on Washington?
I have been wondering recently if it is time for
those of us involved in America’s healthcare –
including citizens affected by both intensified policy
restrictions and Congress’s inability to effect positive change regarding health insurance for all – to
hold a Healthcare March on Washington. Changing
healthcare policy, the continuing cuts to Medicaid
and Medicare reimbursements,
growing numbers of uninsured
and the number of businesses
dropping health insurance for
their employees all have people
extremely concerned. More
than that, their very lives and
livelihoods are at risk. It seems
as though more people each
year forego early retirement
and work until they are 65 just
to qualify for Medicare coverage.
According to every national poll taken within the
past six months, the need for policy improvement
and affordable insurance availability rank among
America’s highest concerns. And in this all-important election year, candidates making their bid for
the presidency continue to mention healthcare, but
are (so far) presenting improvement plans that are
all too sketchy and vague.
It’s time for both talk AND action. Therefore,
your Arkansas Hospital Association board of directors urged all of the state’s hospital administrators
and trustees to attend the annual American Hospital
Association membership meeting in Washington, DC
April 6-9. At press time, more than 30 were signed
up for the trip.
These visits are a win-win for hospital CEOs.
How better to get your elected officials’ direct
attention than to sit down with them, face-to-face,
in meetings designed to detail Arkansas hospitals’
needs, concerns and challenges?
Taking part in the annual membership meeting also
gives administrators and trustees both a voice in and
vital information regarding healthcare policy-setting
in America today. Participants will be bringing home
knowledge from executive briefings on topics such as
The Joint Commission, health information technology,
the future of Medicare and Medicaid, and potential
effects of the 2008 election.
Scheduled educational opportunities for hospital
trustees cover issues such as succession management,
quality and patient safety, and “the gremlins of governance.”
Beth Ingram is serving as our point person on coordinating CEO attendance for the Washington meeting.
To reach Beth, contact her at 501-224-7878 or e-mail
her at [email protected].
In this vital election year, those of us in the hospital
field are going to Washington, together, to join healthcare administrators and trustees from across the nation
in our own virtual “march on Washington” April 6-9.
America’s healthcare policy depends upon it – and
upon your continued interest and participation as the
year progresses!
It’s not quite a march on Washington, but it could
make a significant impact on future healthcare policy
in this vital election year.
We feel the most important events are the times set
aside to meet with the state’s Washington delegation
and their key aides on health matters. The AHA will
host a reception for congressional aides Monday evening, April 7; and on Wednesday, April 9, attendees will
meet with Senators Blanche Lincoln and Mark Pryor for
breakfast, followed by visits with their respective congressman in his Capitol Hill office.
Spring 2008 I Arkansas Hospitals
Phil E. Matthews
President and CEO
Arkansas Hospital Association
Peace of mind.
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Nearly 1,000 healthcare organizations nationwide rely on
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For more than 25 years, the professionals of Hagan Newkirk
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The full time healthcare division of Ramsey, Krug, Farrell
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Our coverages include:
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• Medical Professional Liability for Physicians and Surgeons-- all specialties protected
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• Health Care Organization Directors and Officers and all related corporate and personal needs
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Our Risk Management and claim specialists are experts in medical professional,
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P.O. Box 251510 • Little Rock, Arkansas 72225 • (501) 664-7705
Spring 2008 I Arkansas Hospitals
April 6-9, Washington, D.C.
American Hospital Association
Annual Membership Meeting
April 15, Little Rock
Leaping from Staff to
Management, Mid-Management
Certificate Series
April 16, Little Rock
Leaping from Staff to
Management: The Next Steps,
Mid-Management Certificate
April 22, Little Rock
Compliance Forum
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April 23, Little Rock
Arkansas Health Executives
April 24, Little Rock
Crisis Communications Workshop
April 25, Little Rock
Hospital Emergency Preparedness
May 2, Hot Springs
Arkansas Organization of Nurse
Executives Workshop
May 8-9, Hot Springs
Arkansas Association for Hospital
Engineering Annual Meeting
May 13, Little Rock
Credentialing Clinic
May 14-16, Hot Springs
Society for Arkansas Healthcare
Purchasing and Materials
Management Annual Meeting
May 21, Little Rock
The Legal Aspects of
Management, Mid-Management
Certificate Series
May 28, Little Rock
Hot Topics in Risk Management
June 18-20, Branson, Missouri
Executive/Trustee Leadership
Program information available
at Audio
conference information available at
and Newcomers
James R. “Jamie” Carter, CEO of Crittenden
Regional Hospital in West Memphis, has been
elected to the AHA Board of Directors by the
Northeast District. He will serve the unexpired
term of Leah Osbahr, which ends October 2011.
Carter, who has been at the West Memphis facility since November 2005, also serves on the
Governor’s Advisory Council on Trauma.
Shane Frazier has been named Service Line
Administrator for Post-Acute and Behavioral
Health Services at St. Vincent Health System and
Facility Administrator for St. Vincent Doctors
Hospital in Little Rock. He succeeds Angie
Cabantac who recently retired. Frazier began his
work in the St. Vincent Health System in 2001
as Director of Nursing for Behavioral Health
Services. He has a BSN from the University
of Central Arkansas and an MBA from the
University of Arkansas at Little Rock.
Leland Farnell has been named interim CEO
for Mena Regional Health System, succeeding
Vince DiFranco. Farnell will serve until April
30 when the hospital’s management contract
with QHR expires. He has more than 23 years
of experience as a hospital CEO in community
hospitals in North Carolina, Georgia and South
W. Lee Gentry, FACHE, has been named
administrator of Baptist Health Extended Care
Hospital, which is located inside Baptist Health
Medical Center in Little Rock. Gentry is a former
president/CEO of Lawrence Memorial Hospital
in Walnut Ridge, vice president of operations at
St. Joseph’s Mercy Health Center in Hot Springs,
and COO of Northwest Regional Medical Center
in Clarkesdale, Mississippi.
Phillip Gilmore, FACHE, president/CEO of HSC
Medical Center in Malvern and president of the
Arkansas Health Executives Forum, announced
that AHEF has received the American College of
Healthcare Executives (ACHE) Award of Chapter
Distinction. ACHE president Thomas Dolan congratulated the organization saying, “Achieving this
award is a great accomplishment and solid evidence
of the significant hard work of your leadership
throughout the past year.”
Governor Mike Beebe has named Edward L.
Lacy, FACHE, vice president/administrator of
Baptist Health Medical Center – Heber Springs,
to the Oversight Committee on Breast Cancer
Research.  Lacy’s term expires January 1, 2011.
Brett A. Kinman has been named CEO at Forrest
City Medical Center, succeeding Stephen Doherty
who served in an interim capacity during the search
period. Kinman was previously assistant CEO at
Scenic Mountain Medical Center in Big Spring,
Texas, and COO at Harris Hospital in Newport. He
has ten years of healthcare management experience.
Franklin G. Schupp has been named president
of SMC Regional Medical Center in Osceola. He
succeeds Keith Broach. Schupp was previously
president of health development and associates for
Ameris, the company that operates SMC. He also
has experience as a CEO and development director
with Cumberland Health Systems, Metropolitan
Hospital in Chattanooga (TN), and Medshares, Inc.
M. Kent Strum is serving as interim administrator for Delta Memorial Hospital in Dumas, succeeding James Fairchild. Strum is from Jackson,
Mississippi, with healthcare experience as a CEO
and consultant.
Spring 2008 I Arkansas Hospitals
Hospitals Respond in
Tornado’s Aftermath
Aerial photo of the destruction at Stone County Medical Center in Mountain View following
a February 5 tornado that tore through Arkansas.
The F4 tornado that tracked on
the ground for 123 miles across
North Central Arkansas in the late
afternoon of February 5 left a wide
footprint of destruction from the
Arkansas River Valley northeast
to the Missouri border. Among
the most severely damaged areas
in the storm’s path were communities where two of the state’s 28
Critical Access Hospitals are located: Mountain View and Clinton.
In the midst of and immediately after the storm, Stone
County Medical Center (SCMC) in
Mountain View (part of the White
River Health System in Batesville)
continued to care for injured
patients despite receiving significant damage. The tornado hit
Spring 2008 I Arkansas Hospitals
the hospital just as the Leadership
Team was concluding its regularlyscheduled meeting. Fortunately,
the entire team was on hand.
The emergency department at
SCMC sustained severe damage,
enough to temporarily close the
facility to inpatients until repairs
were completed. But during and
after the storm, the surgery department remained open as an emergency assessment, treatment and
transfer center after the tornado
tore through the community.
No patients or employees of the
hospital were injured as a result
of the storm. The 17 patients who
were in the hospital at the time the
storm hit were evacuated to Stone
County Nursing and Rehabilitation
Center, to other facilities for care,
or discharged to their homes.
Just 24 days after the tornado,
SCMC began admitting patients
for care, opening 12 of the hospital’s 25 beds after approval by the
Arkansas Department of Health.
“These rooms, along with our
surgery department were spared
from the storm,” said Karen Craft,
SCMC Administrator.
Structural engineers continue to
assess the damage to the facility and are developing a plan to
rebuild and renovate the hospital.
A modular medical building previously used as a temporary facility in Corpus Christi, Texas, was
assembled on the hospital campus
to provide space needed to contin-
ue operations during the rebuilding
process. The ER, laboratory, X-ray,
respiratory therapy, pharmacy and
other ancillary services are moving
into that space. Additionally, three
physicians whose offices were damaged in the storm were scheduled to
reopen their clinics in the building
in mid-March.
Craft said, “Our hospital family
and community have come together
to rebuild the hospital after the
horrific February tornado. I am
so proud to be associated with this
group of physicians and employees.
They demonstrated compassion,
courage and commitment on that
night and every day following. I am
confident about our future.”
tornado’s touchdown, the hospital
saw 51 patients, assessing and treating many onsite and working with
area ambulance services to transport other more severely injured
people to hospitals in Conway and
Little Rock.
Reamey said that the hospital
staff and volunteers continued their
medical treatment of storm victims
until midnight, but pressed on into
the morning hours and the following days, providing assistance to
area residents in the form of food,
shelter and other non-medical care.
He also commented on the local
disaster response plan and said that
it worked well in his community,
with all parties handling their roles
those families who suffered injuries
or loss,” stated Mike McCoy, Saint
Mary’s CEO. “The compassionate
staff of Saint Mary’s is regularly
trained and well prepared for emergency situations. I am very proud
and grateful for how our staff and
physicians responded during this
time to care for the injured and
keep concerned family members
informed. We have a great team
of staff, clinicians and physicians
who consistently help us to fulfill
our mission of delivering quality
healthcare with courtesy and compassion.”
And, just as they’ve been trained
to do, many other hospitals, physicians, nurses and staff across the
SCMC employees erected a flagpole and sign to show the community of Mountain View that a tornado will not destroy the hospital.
Undamaged in a community
fraught with destruction, Ozark
Health Medical Center (OHMC) in
Clinton became the focal point for
local residents as they sought out
care and assistance in the storm’s
Ozark Health CEO, Kirk
Reamey, who serves as a member of
the Arkansas Hospital Association
board of directors, reported to the
board that within two hours of the
and responsibilities admirably.
The Atkins area was hard hit as
well by the tornado. Saint Mary’s
Regional Medical Center in nearby
Russellville was well prepared for
the event – quickly putting into
action many aspects of its wellrehearsed disaster plan.
“The tornado event of February
5 reminded us that natural disasters can cause much damage and
pain. Our prayers remain with
state provided supplies, transportation, treatment and care for tornado victims and families following the tornado. The February 5
disaster was a true test of the plans
that hospital representatives, emergency medical personnel, the Office
of Emergency Services, community
leaders and others have worked on
together to care for and make our
communities safer no matter what
type of disaster occurs.
Spring 2008 I Arkansas Hospitals
by Paul Cunningham, Senior Vice President, Arkansas Hospital Association
Thoughts on the President’s Budget Proposal,
and How it Affects Hospitals
When President Bush released
his proposed federal budget for
Fiscal Year 2009, he didn’t necessarily set the full advocacy agenda
for America’s hospitals for the year,
but he certainly gave it an immediate focus. The proposal would cut
$182 billion from future Medicare
spending over the next five years.
About $135 billion would come
from hospital payments.
Frankly, we can’t afford for that
to happen.
Even in the best of times, cuts
of that size would devastate many
hospitals and create havoc over
the entire healthcare delivery system. But, these particular cuts are
being pushed at a time when the
economy is tanking. That means
other hospital payment sources will
likely dry up, multiplying the disastrous effects.
More than that, the demand for
hospital services verges on rising to
historic levels as roughly 20 million baby boomers – and that may
be a conservative estimate – will
reach the milestone age of 60, and
beyond, by 2013. As early as 2011,
the oldest boomers will become
eligible for Medicare, and by 2015,
at least 10 million of them will join
the circle of beneficiaries, despite
their later eligibility ages.
Everyone understands that
Medicare’s long-term financial outlook is shaky, due in part to the projected growth in per-capita costs,
but mostly because of increases in
the beneficiary population, which,
Spring 2008 I Arkansas Hospitals
according to the data, is about to
get much bigger.
To make matters worse, while
60 may be the new 50 on a sort
of ethereal, transcendental plane,
many of the old physical problems
will still hang around to nag even
the healthiest of boomers. Dealing
with some of those less coveted
perks of aging will become a new
way of life and, for many, will be
the ultimate boomer bummer.
In another five or 10 years, an
assortment of maladies will begin
to catch up with literally millions
more Medicare patients. They’ll
find themselves with conditions
ranging from chronic obesity,
arthritis, diabetes and knee/joint/
back pain to acute bouts with heart
attack, cancer and stroke.
There’s no denying that the longer we live, the more likely it is that
a physical ailment of some type will
eventually latch onto us and refuse
to let go.
In mid-February, the President
sent Congress a bill that would take
a three-step approach to strengthening Medicare. It includes improved
health information technology and
electronic medical records; transparency in price and quality information; and incentives for providers to deliver and Medicare beneficiaries to choose high-quality,
low-cost healthcare.
All could be sound moves; however, he wants to jumpstart the salvage job with his proposed budget
Would that cut Medicare spending? Well, yes, but at what cost?
When maladies begin to strike
baby boomers in the form of heart
attack, cancer, stroke and other
conditions, they’ll need Medicare,
just as older patients do today.
But, even more, ailing boomers
will need the peace of mind of
knowing that healthcare services,
including hospital care, are available to treat them in their own
If the budget proposal goes
through, local healthcare may not
be available, especially in rural
states like Arkansas where hospitals that already struggle to survive
every day on paper-thin margins
won’t make it. That won’t only
hurt Medicare beneficiaries, but it
will affect everyone else who lives
in those communities, too.
Administration’s bill, Department
of Health and Human Services
Secretary Michael Leavitt said that
the President hopes the steps will
assist Medicare beneficiaries in
making healthcare choices, which
will lead to Medicare savings.
In a convoluted way of thinking,
it might work. Do away with $135
billion in hospital reimbursements
(about $940 million in Arkansas)
and future decisions about where
to obtain high quality, low cost
healthcare services will be much
easier, since those choices, due to
hospital closings, will be severely
FORTUNE Magazine Names Arkansas
Children’s Hospital to its “100 Best
Companies to Work For” Listing
FORTUNE magazine announced
in January that Arkansas Children’s
Hospital in Little Rock has been
ranked 76th on the 11th annual “100
Best Companies to Work For” list. 
“Arkansas Children’s Hospital
is honored to be ranked among
FORTUNE’s ‘100 Best Companies
to Work For’ survey,” said ACH
President and CEO Jonathan Bates,
M.D.  “Our employees take much
pride in providing care, love and
hope to our kids here at ACH. 
Their survey response, which
comprised the largest portion of
the survey, is what matters most,
and they feel that ACH is a very
rewarding place to work.”
recognized under the category
“Unusual Perks” for offering
a pre-kindergarten fitness
program by trained staff and
ranked number one in the
Onsite Child Care category for
companies that have “an onsite
child-care center” with “least
expensive, average monthly
A driving factor for the list
this year is that these companies
excel in creating jobs.  The 100
companies on the 2008 list added
67,000 employees to their payrolls
in the past year and employ a total
of nearly 1.6 million employees;
up 16 percent from the number
employed by companies comprising last year’s list.
“The FORTUNE ‘100 Best
Companies to Work For’ ranking
achieved by Arkansas Children’s
Hospital we hope will help us
attract more physicians, nurses
and other quality staff to our
hospital.  We believe one of the
positives for Arkansas is that this
recognition will help other companies recruit outstanding employees
to their business and our state,”
added Bates.
Any company that is at least
seven years old with more than
1,000 U.S. employees is eligible.
For an online nomination form, go
Editor’s Note: Let us hear
about your hospital’s national recognition! Please send information
and photos to Beth Ingram at [email protected].
Wal-Mart, LR System Partner Up
Stores Inc. announced plans in
February to partner with Little
Rock’s St. Vincent Health System to
set up walk-in, primary care clinics
in four Wal-Mart Supercenter locations in the Little Rock area.
The Little Rock clinics are among
the first in Wal-Mart’s effort to estab-
lish a series of such “co-branded”
clinics across the country in conjunction with local hospitals. Essentially,
St. Vincent and other partnering
hospitals will be leasing space in
the selected stores and providing all
operational resources, from healthcare personnel to the filing of insurance claims.
According to Wal-Mart officials,
the company hopes to have 400
of the hospital-operated clinics in
place by 2010. The retailer has
offered walk-in clinics in some
stores for the past few years, but
those clinics are not associated
with hospitals, as the newer clinics
will be.
Spring 2008 I Arkansas Hospitals
by Nancy Robertson Cook
Providing Cancer Patients
with “Hope Away from Home”
Ask any member of the 20 th
Century Club in Little Rock what
the group’s purpose is, what they
stand for, and you’ll get a unanimous answer:
“We try to make the lives of
cancer patients easier, plain and
Well, perhaps not plain,
and certainly not simple. This
65-years-young independent civic
group, with more than 100 active
and 300 sustaining members, has
taken upon itself the monumental
goal of raising $3 million within
a year’s time. Their purpose: to
build a state-of-the-art, homelike lodge to house financiallyburdened cancer patients undergoing treatment in one of Little
Rock’s many medical facilities.
Their mantra: “We’re building a
bridge of hope.”
The group has been known
for more than 20 years as a
Spring 2008 I Arkansas Hospitals
resource for no-cost housing for
financially strapped, out-of-town
cancer patients receiving treatment in the Little Rock area. In
the past, they have helped about
250 patients annually, providing
1500-2400 room nights of nocost housing per year. When the
new facility is built, those numbers will approximately triple.
“Doctors and hospital staff
from all over the state send their
patients to cancer treatment facilities in Little Rock every day,”
says Lynda Johnson, a partner
with the Little Rock law firm of
Friday, Eldredge and Clark and
steering and planning committee chairman for the new lodge.
“They know that if their patients
have financial difficulties, our
group can be counted upon to
help with housing during periods
of treatment.”
“Even a solid, middle-class
family can quickly become financially devastated when cancer
is the diagnosis, though they
may have medical insurance,”
says Hope Lodge president Lisa
Johnson. “Oftentimes, people
come expecting their treatment
to last 1-2 days, but it extends
to 4-6 weeks. The out-of-pocket
cost of hotels and eating out during these treatment periods can
be a tremendous financial burden
on patients and their families.”
Lynda and Lisa, along with
fellow group member Dana
Kleine, serve as leaders of the
group’s capital campaign effort,
announced in January. “I have
been involved with fundraising
for many years, and there are so
many worthy non-profit organizations and projects,” Dana
says, “but this project has just
struck a chord with me. We are
all passionate about building this
new lodge for cancer treatment
A Capital Campaign to
Raise $3 Million
Currently, the capital campaign
is in full force. “We hope that
hospitals, hospital foundations,
physicians and auxiliary groups
will realize the service our lodge
provides to people in their communities as they come to Little
Rock for cancer treatment,” Lynda
says, “and will consider contributing to the building of this $3
million facility. It is a great way
for them to help their own communities – their hometown folks
– since it is these patients that
we serve through the lodge. We
would appeal to hospitals and
the medical community (including
primary care physicians, oncologists and other physicians) to help
us serve their patients better.”
Physicians, who work through
hospital social workers and discharge staff members, refer
patients to the lodge. They are
carefully screened for financial
need and hardship. “Today, when
patients are referred to us, they
go through our patient liaison,
who sets up the reservation in
our interim housing facility (the
Baptist Health Plaza Hotel),” Lisa
says. “When they realize there is
a no-cost lodging facility available
to them, you can see them move
from panic to relief.”
“Our patient liaison is the
group’s only paid staff person,
and she is part-time,” Lynda
explains. “Otherwise, all monies
raised go directly to operations of
the interim lodge, building of the
new lodge or patient services.” It
has been documented that more
than 98 percent of funds raised by
the group go to help patients.
The fundraising campaign is
beginning where it should, Dana
says, within the membership of the
20th Century Club itself. “We are
seeking, and know we
will achieve, financial
commitments from
100 percent of our
active membership,”
she says. “People will
be giving at the levels they can afford to
give, but every mem- Dana Kleine
ber is behind this
project and dedicated
to it.”
“It is like I tell my children,”
she says. “To whom much is
given, much is expected. We are
all so blessed, we each have something we can contribute to this
These organizational leaders are
particularly proud of the fact that
the 20 th Century Club is made up
of dedicated volunteers with many
talents, coming from many backgrounds and professions. “We are
an all-women group with diverse
and wide-ranging talents,” Lisa
and Dana say. “We are combining
our talents for the greater good,
and with the building of this new
lodge, we will leave the world a
better place.”
“This organization and our
work for cancer patients is near
and dear to all of our hearts,”
Lynda says. “We want to raise
this money and get the building
built! It will be a great legacy for
our group to leave to our community.”
As the Word Gets Out
The group is discovering that
as word about their new facility
gets out, people are looking for
ways to help.
“We received a call the other
day from an electrical contractor,” Dana says. “He offered to
provide all of the new building’s
electrical fixtures and equipment
at cost; such a generous donation.”
“In-kind donations from contractors and those in the construc-
Lynda Johnson
Lisa Johnson
tion industry are most appreciated,” Lynda says. “Every donation
of equipment and services helps
us move closer to getting the new
lodge built. Currently, we plan to
break ground in December 2008
and open the facility to patients
by December of 2009.”
The New Lodge
The new lodge will be located
in the heart of the I-630 medical
corridor in Little Rock, at the
corner of Maryland and Cedar
Streets. It will include 21 patient
suites, up from the eight patient
rooms in the former Hope Lodge.
Each patient suite will have
its own private bathroom and
will contain both a double bed
and a single bed, so patients can
have their caregiver in the room
with them. The patient suites
also house mini-kitchens, so each
patient can make their suite a
“home away from home.”
Key to the new facility is the
fully-equipped communal kitchen
and dining room, where patients
and caregivers can cook their own
meals and share conversation and
experiences with others like them.
“Once a week, our group members
prepare a home-cooked meal for
those staying in the lodge,” Lisa
says. “We eat with the patients,
check on how their treatment is
going, listen when they want to
talk. Once you do one dinner,
you’re hooked!”
The communal kitchen is one
feature the patients really apprecicontinued on page 14
Spring 2008 I Arkansas Hospitals
continued from page 13
ate. “It offers a place of camaraderie, a place to share experiences,” she says. “When people are
getting cancer treatments, it often
makes them feel nauseated, and
going out to a restaurant or for
fast food is just not a good option.
Here, they can have
a bowl of chicken
soup, a meal that
is easy on the
Also central to
the new facility
will be the great
room, where people can gather to
talk or watch television, a library
with up-to-date cancer literature,
medical and leisure books to borrow, and computers so they can
do research or check their e-mail.
And soothing outdoor spaces
are also going to be important.
“We actually have a Bridge of
Hope designed as a water feature on the property,” Lisa says.
“There is also a courtyard and
veranda where people can spend
some time outdoors in a protected environment...where they can
meditate, enjoy the sunshine, be
at peace.”
“Before setting out to plan
this new facility, we checked with
social workers throughout the
medical sector to make certain
there was truly a need for a facility this size,” Lynda says. “We
were told that they feel the facility
will be filled to capacity from the
very first day.”
A History of service
The 20 th Century Club was
founded in 1941 with the idea of
supporting the Red Cross and the
USO by making bandages, clothing and food items to be used in
the war effort. As the organization matured, its purpose gained
a pinpoint focus: working to ease
the lives of cancer patients.
Spring 2008 I Arkansas Hospitals
In 1984, the group identified a
need for short-term housing for
out-of-town patients coming to
Little Rock facilities for cancer
treatment. They envisioned a lodge
of hope, a safe harbor, and raised
money to provide such a place.
Soon, they purchased a
home in Little Rock’s
historic Quapaw
Quarter and named
it Hope Lodge; it
was a place where
up to eight radiation and chemotherapy patients at a time
could stay at no charge,
relieving the financial burden of
the cost of lodging during cancer
But patients received much more
than a safe harbor at Hope Lodge.
They also were graced with homecooked meals, shoulders to lean
on, people who would take the
time to listen to their experiences,
and the compassionate kindness
of gentle strangers dedicated to
their comfort.
For more than 20 years, Hope
Lodge served as a beacon of hope
for Arkansans (and others) coming to Little Rock from rural communities to receive their cancer
But the cost of upkeep on a
historical building is high, and the
need for more housing was great.
Also, the building’s designation as
a historical home made it impossible to add elevators, private baths
and room for family caregivers.
So, in 2005, the 20 th Century
Club sold Hope Lodge and began
providing the finances necessary to house cancer patients at
the Baptist Health Plaza Hotel.
Home-cooked meals and the
shoulders to lean on were still
provided, but the group became
increasingly aware that it needed
to provide a dedicated home away
from home for the state’s cancer
patients forced to travel to receive
their treatments.
The idea of building a state-ofthe-art facility, created specifically
with the needs of cancer patients
in mind, was born.
The capital campaign for the
new facility was announced in
January at this year’s Hope Ball,
the group’s one and only annual fundraiser that provides the
money for the lodge’s patient services and daily operations.
Into the Future
The group is confident that
ground for the new facility will be
broken in December of this year,
and that after a 9-12 month construction period, the new lodge,
as yet unnamed, will be ready to
receive patients and caregivers.
“So many patients have told
us they don’t know what they
would have done without no-cost
housing while they’re receiving
treatment,” Lisa says. “Many
have said that if they hadn’t had
a place to stay, they would have
been financially forced to remain
at home and would not have been
able to travel to receive treatment.
That puts our service into true
And she sums up the 20 th
Century Club’s work by reiterating what one patient said, bringing the focus back to their mission:
“After being diagnosed,
I came here for a place to heal.
After being shown the love and
compassion I received here, I’m
leaving the lodge with a reason
to live.”
To offer monetary or in-kind
donations for the new lodge, please
contact steering and planning committee chair Lynda Johnson by
e-mail at [email protected] or by
phone at 501-370-1553, or visit
the lodge on the Web at www.
Joint Commission Sentinel Event Alert:
Preventing Accidents and Injuries in
the MRI Suite
Magnetic resonance imaging (MRI) was applied to health
care in the late 1970s to provide
never-before-seen two- and threedimensional views of body tissue
and structure. Today, more than
10 million MRI, or MR, scans
are done in the United States each
year. While the capabilities of the
MRI scanner are well-recognized,
its inherent dangers may not be as
well known.
The most common patient injuries in the MRI suite are burns and
the most common objects to undergo significant heating are wires
and leads. Other objects associated
with burns are pulse oximeter sensors and cables, cardiorespiratory
monitor cables, safety pins, metal
clamps, drug delivery patches
(which may contain metallic foil),
and tattoos (which may contain
iron oxide pigment). Less common
injuries involve pacemakers. The
American College of Radiology
recommends that implanted car-
diac pacemakers and implantable
cardioverter/defibrillators should
be considered a relative contraindication for MRI. Any exception
should be considered on a caseby-case basis and only if the site
is staffed with individuals with the
appropriate radiology and cardiology knowledge and expertise.
Five MRI-related cases in the
Joint Commission’s Sentinel Event
database resulted in four deaths
and affected four adults and one
child. One case was caused by
a projectile; three were cardiac
events, and one was a misread
MRI scan that resulted in delayed
The Joint Commission offers
recommendations and strategies to
healthcare organizations for reducing MRI accidents and injuries
in its most recent Sentinel Event
Alert. The complete Alert may be
found at www.jointcommission.
org by clicking on the “sentinel
event” tab.
AHA Services Launches New Web Site
AHA Services, Inc. has a new
Web site, just launched at www.
AHA Services, Inc. is a wholly
owned subsidiary of the Arkansas
Hospital Association, and links
AHA members with purchasing, education and management
resources. The group purchasing
advantages offered by these companies to AHA members saves
Arkansas hospitals thousands of
dollars each year.
“We launched this Web site
to give AHA members a place to
easily access the companies we
endorse,” says Tina Creel, vice
president of AHA Services, Inc.
“When people go to our new
Web site, they will be able to find
information about what each of
these companies offers, as well as
find ways to contact our endorsed
companies if they have questions
about their services.”
Also on the Web site are links
to all publications available from
AHA Services, Inc., and a form
where members can select the
companies about which they’d like
to learn more. “When people fill
out these forms, we will get back
to them with the information they
seek,” Creel says. “It’s a way
our members can have 24-hour
access to information about our
resources, educational Webinars,
endorsed companies and the group
purchasing plans they offer.”
Spring 2008 I Arkansas Hospitals
Hospital executive/Trustee Leadership
Conference Planned for June 18-20
Join your peers for the annual Hospital Executive/Trustee
Leadership Conference (formerly named the Arkansas Hospital
Administrators Forum/Arkansas
Health Executives Forum Leadership
Conference) to be held June 18-20
at the Chateau on the Lake in
Branson, Missouri.
For the first time, the summer
conference will offer a forum for
hospital executives and trustees
to come together to forge a better understanding of healthcare
issues. The faculty is highlighted by
Stephen Mayfield, senior vice president for quality and performance
improvement for the American
Hospital Association and director
of the AHA Quality Center, who
will discuss collaborative leadership
for quality and healthcare optimization. Carl Abraham, M.D., an
infectious disease specialist from
Jonesboro, will discuss community
strategies for managing infectious
disease risks, with a focus on his
experience with MRSA (Methicillinresistant Staphylococcus Aureus).
In addition, Karen Craft and Tony
Thompson of White River Health
System will discuss lessons learned
from the devastating tornado that
damaged Stone Co. Medical Center
in Mountain View earlier this year.
educational activities, Branson
offers many opportunities for family
entertainment – golfing, outlet malls,
fishing, boating, swimming, tennis,
a full range of musical entertainment
for all ages and tastes, and much,
much more –
which make the
trip to Branson
will be available
soon, but you
are encouraged
to make hotel
now by calling Chateau on the Lake
Mention the Arkansas Hospital
Association for special room
rates. Contact Beth Ingram at
(501) 224-7878 for additional
Call for 2008 Diamond Award Entries;
April 11 Deadline
The 2008 Arkansas Hospital
Association (AHA) Diamond Awards
Call for Entries has been announced.
The open nominations are cosponsored by the Arkansas Hospital
Association (AHA) and the Arkansas
Society for Healthcare Marketing
and Public Relations. Last year, 23
hospitals received awards presented
at the AHA’s Annual Awards Dinner
held in conjunction with the AHA
Annual Meeting and Trade Show.
This year’s recipients will receive
their awards during the October 9,
2008, Awards Dinner at the Peabody
Hotel in Little Rock.
The 2008 Diamond Awards
honor excellence in hospital marketing and public relations and will
be presented in several categories,
such as advertising, annual report,
Internet Web site, publications,
special video production, and writ16
Spring 2008 I Arkansas Hospitals
ing. Diamond Awards (for hospitals with 0-99 beds, 100-249
beds and 250 or more beds) will
be presented in each category.
Entries will be judged by a
panel of judges not affiliated
with any Arkansas hospital. Nominations and entries,
accompanied by appropriate
documentation, must arrive
at AHA headquarters no later
than April 11, 2008. A brochure providing details of
the awards competition was
mailed to hospital CEOs and
marketing and public relations directors.
Please call Lyndsey Dumas
at (501) 224-7878 with questions about the awards or
award process.
2008 Diamond A
Call for Entries
Arkansas Hosp by the
ital Associatio
Arkansas Socie
ty for Healthc
Marketing an
d Public Relat
For Excellence in
Marketing and P Hospital
the 2008 Diamon lic Relations,
d Award goes to
Harding University Receives Pre-Candidate
Accreditation Status for its College of Pharmacy
Harding University in Searcy
has earned pre-candidate accreditation status for its College of
Pharmacy and will seat its first
class of 60 students this fall.
More than 245 applications were
received for the inaugural class.
Students graduating from the
four-year program will earn their
doctor of pharmacy (Pharm.D.)
“A newly instituted doctor of
pharmacy program of a college
or school of pharmacy must be
granted each of two pre-accreditation statuses at the appropriate
stage of its development,” said
Dr. Julie Hixson-Wallace, dean of
the College of Pharmacy.
Representatives from the
Pharmacy Education (ACPE)
conducted the first pre-candidate
accreditation visit in mid-Novem-
ber, and the first stage of accreditation was approved in January.
This means that Harding has
properly planned for its doctor of
pharmacy program and designed
it according to ACPE guidelines
and standards.
A second site visit will be held
in the spring of 2009. That
visitation will determine whether
Harding has met the requirements
to advance to candidate status.
New OIG Advisory Opinions
The Department of Health and
Human Services’ Office of the
Inspector General on January 14
released two advisory opinions
regarding arrangements between
hospitals and physician groups
with potential to violate the antikickback statute. One arrangement allowed anesthesiologists
and the other cardiac surgeons to
share in a portion of the hospital’s cost savings in exchange for
implementing cost-saving strategies.
In both cases, OIG said it
would not impose administrative
sanctions on the parties involved,
concluding, “Properly structured,
arrangements that share cost savings can serve legitimate business
and medical purposes.”
The OIG noted that the opinions, which are available at http://, affect
the parties involved and should
not be interpreted to apply to all
Spring 2008 I Arkansas Hospitals
Arkansas Hospital Utilization Moves Downward
2004-2006; Spending Continues to Increase
The newly released Hospital
Statistics 2008, published by the
American Hospital Association,
shows that utilization for
Arkansas community hospitals
trended downward between 2004
and 2006, the latest period for
which full-year data is available.
Despite the lower use, the total
hospital spending continued a
steady increase at around 3.5
percent per year for the period.
Hospital admissions were off 1.84
percent from 2004 levels, and
inpatient days of care fell almost
3.0 percent. Adjusted patient days
vided through Arkansas’ hospitals increased more than 12 percent from 2004 to 2006 and has
been up about 110 percent since
Total expenses related to
deductibles and co-pays not covered by insurance, plus care provided to self-pay patients who
can’t afford the out-of-pocket
costs, has risen 41 percent since
2000. The table accompanying
this article compares selected utilization and financial indicators
of the state’s community hospitals
for 2003, 2004 and 2005.
Community Hospital Indicator
Beds Available for Use
9,580 9,389
382,836 380,067
Inpatient Days
Non-Emergency OP Visits
3,707,485 3,818,276
Total Outpatient Visits 4,842,303
4,971,307 5,085,474
Adjusted Inpatient Days 3,266,473
3,269,871 3,174,935
58.6% 58.4% 57.2%
Inpatient Surgeries 115,512 126,374 108,651
Outpatient Surgeries 146,074 141,104 144,619
Total FTE Employees 42,629 42,802 43,074
4.76 4.78 4.95
Inpatient Charges $6,513,778,911 $6,962,421,549 $7,346,539,305
Outpatient Charges $3,861,410,128 $4,238,194,924 $4,655,737,561
$10,375,189,039 $11,200,616,473 $12,002,276,866
Bad Debt Expense $565,220,366 $566,152,497 $593,842,343
Charity Care Provided $239,575,478 $293,504,071 $330,914,742
Payments for Patient Care $4,014,406,025 $4,255,599,395 $4,429,611,124
Total Operating Costs $4,015,475,758 $4,225,289,800 $4,437,596,804
Occupancy Rate (Staffed Beds) FTEs/Adjust. Occupied Bed Total Patient Care Charges Patient Care Margin 18
of care, which translates outpatient (OP) visits into patient day
equivalents, also dropped about
3.0 percent.
However, hospital emergency
rooms and outpatient departments continued to get busier as
the state’s hospitals hit a new
record with more than five million outpatient visits.
The indicator that continues to present the most concern
among hospital officials is growth
of services provided to underinsured and uninsured patients.
The amount of charity care pro-
Spring 2008 I Arkansas Hospitals
-0.03% 0.71%
AHA Will Intervene On PPA Matter
In February, the Arkansas Hospital
Association (AHA) petitioned the
state Insurance Commissioner with a
Request to Intervene in a hearing to be
held on a December 2007 Order involving the Patient Protection Act (PPA) of
1995. In her Order, Commissioner
Julie Bowman said that the Act – the
state’s Any Willing Provider (AWP) law
– does not require that every Arkansas
hospital receive an identical reimbursement for the same services.
A pre-hearing conference was held
February 14 to decide the standing of
AHA and other parties to intervene.
The Commissioner’s order was
released following a departmental
investigation into a complaint registered by the Arkansas Surgical Hospital
involving “discriminatory payment
rates” under the PPA. The law prohibits insurers from imposing a monetary advantage or penalty under a
health benefit plan that would affect a
patient’s choice among hospitals.
The Commissioner subsequently
its payment structure; the burden the
found that the PPA does not, and was
hospital must carry in order to prove
not intended to, equalize all hospital
that a violation of AWP occurred; and
reimbursements or prohibit negotiawhether the payment differences were
tion of reasonable, yet different reimbased upon “quality or cost reasons”
bursement terms between health plans
or were “solely related to the different
and their network providers, based
size and scope of services provided” by
upon legitimate criteria.
the hospital.
Her finding agreed with the AHA
The hospital also has asked to
interpretation that the Act requires all
inspect all evidence that was considproviders be given an equal opportuered by the Commissioner in making
nity to participate in a health plan’s
her determination.
provider network, as long as they are
During the February 14 session,
willing to accept the terms and conBowman granted Intervenor status to
ditions of the plan; but it does not
the AHA, the Sisters of Mercy Health
address reimbursement issues.
System and the Surgical Hospital of
In January 2008, Sam Perroni, an
Jonesboro and denied similar requests
attorney representing Arkansas Surgical
from two other petitioners. She also
Hospital, requested a hearing before
postponed the formal hearing date
the Commissioner regarding her order.
from FebruaryFAX
to April 14,T2008.
Perroni askedARKANSAS
to the Arkansas
evidence on
the primary
whether the
payment differences would CO.:
(501) 375-2985 ext.
(501) 375-2985
in theext.hearing will be three
affect a patient’s choice in violation of PH: involved
(501) 375-9565
FAX:Arkansas Blue CrossFAX:
health 375-9565
plans (Arkansas Blue Cross
AWP; whether
Blue Shield, QualChoice and United
Blue Shield actually “negotiated” with
ISSUE DATE:____________
nlr bp
ISSUE DATE:____________
Care). 07
Arkansas PUBLICATION:______________________
Surgical Hospital
Take your first steps.
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Whether an individual has been recently injured or has
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I Arkansas
publication. The Arkansas Times bears no liability. Production charges will
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publication. The Arkansas Times bears no liability. Production charges will be billed to me on my advertising invoice.
2008 Mid-Management Series
Begins April 15
For the third consecutive year,
ship skills and competencies. The
the Arkansas Hospital Association
Mid-Management Series offers the
(AHA) will offer a Midbenefit of presenting an excellent
Management Certificate Series over
opportunity for the new manager
an eight-month period, beginning
to obtain that training, while at
this spring. The
the same time
first workshop for
improving the
the eight-part 2008
hospital’s ability
series will be held
to retain good
April 15, with the
managers and
final session schedfront-line staff.
Certificate Series
This series
Managers & Supervisors
builds on the
A key purpremise
pose of the Midmanagers
repreA series of
8 Educational Workshops
sent their hospioffering skills and knowledge
hospital managers need
Series is to provide
tal and are the
as they lead!
mid-level hospiprimary influtal managers with
ence on employthe tools needed
ees’ desires to
to strengthen the
work for the
direct relationship
between them and
Studies show
their employees,
and, in turn, to reduce employee
supervisor/employee relationships
turnover for AHA member hospiare the No. 1 reason staff memtals.
bers leave their jobs, underscoring
In addition, the Mid-Management
the supervisor’s ability to create
Series provides individuals who
an environment of mutual trust,
move into management positions,
respect and open communication
often with little training, the needas a key driver of employee comed assistance in developing leadermitment and productivity.
April 15
Leaping from Staff to Management:
You’re a Manager...Now What?
April 16
Leaping from Staff to Management...the
Next Steps
May 21
The Legal Aspects of Management
August 13
Financial Skills for Managers
September 23
Dealing with Conflict
September 24
Accountability for Results
October 22
Getting Results: Be an Inspirational
Facilitator, Trainer and Coach
November 20
Government Relations 101
series dates and topics
April 15: Leaping from Staff
to Management: You’re a
Manager…Now What?
April 16: Leaping from Staff
to Management: You’re a
Manager…the Next Steps
May 21: The Legal Aspects of
August 13: Financial Skills for
September 23: Dealing with
September 24: Accountability
for Results
October 22: Getting Results: Be
an Inspirational Facilitator,
Trainer and Coach
November 20: Government
Relations 101
Series and workshop information has been mailed to AHA
member hospitals. It is also available on the AHA Web site at
Please contact Beth Ingram at
(501) 224-7878 or [email protected] for additional information or to register for the series.
United Healthcare revises
Notification Policy
Responding to hospitals’ concerns, United Healthcare is revising its new inpatient admissions
notification policy to allow contracting hospitals to provide notification of all weekend and federal
holiday inpatient admissions by the
next business day through June 30,
Hospitals will still need to notify
Spring 2008 I Arkansas Hospitals
United of any weekday admissions
within 24 hours in order to receive
full reimbursement of their contracted rates. United also said it
will conduct a pilot study of 200
facilities to identify and address
any operational issues with the
new policy, which went into effect
December 3, 2007.
Under the policy, hospitals that
provide notification between 24
hours and 72 hours of admission
will see a reduction of 50 percent
of the average daily payment rate
for each day preceding the notification. If the notification is provided
after 72 hours, or not at all, the
reimbursement reduction will be 50
percent of the contracted rate for
the entire admission.
We salute 2007 Nursing Compassion Award Winner Patrick
Stage, Runner-up Nancy Meneley and all of our nominees!
Exciting plans are in the works for
the upcoming Nurses Week celebration
May 6-12!
We’re organizing activities across the state to
recognize nurses including:
Arkansas Naturals Game
May 7
Arkansas Twisters Game
May 10
Arkansas Travelers Game
May 12
Plus retailer discounts and much more!
Visit for more information.
My Choice.
Kathy Alsobrooks Arkansas Department Searcy
of Health
Connie Beaumont Ozark Health Medical Clinton
Lola Bertling
Brookwood Nursing DeQueen
& Rehabilitation
Area Agency on Aging Pine Bluff
of Southeast Arkansas
Deanna Marie
Drew Memorial Hospital Monticello
Jacobs Bullington
Linda Chadick
Heritage Physician
Hot Springs
Amanda Charles
Area Agency on Aging Pine Bluff
of Southeast Arkansas
Kathy Cheatham
Department of Health Melbourne
Barbara Clark
Millard-Henry Clinic Russellville
Liz Cochran
Arkansas Hospice
North Little
Kathy Cox
Twin Lakes Medical Mtn. Home
Carla Dorr
Mindy Doyle
White River Medical Batesville
Andrew Fletcher
Arkansas Methodist Paragould
Kindal Funr
Mena Medical Home Mena
Health and Hospice
John N. Green
Mtn. Home
Ginger Harris
Henderson State
Ginny Hartnett
Mena Regional
Health Systems
Debra Holmes
Oak Ridge Nursing
El Dorado
Pamela Hoskins
Golden Living Center Monticello
Twyla Jamerson
Area Agency on Aging Pine Bluff
of Southeast Arkansas
Susan Jasay
Area Agency on Aging Pine Bluff
of Southeast Arkansas
Ethel Johnson
Christus St. Michael Texarkana
Health System
Patsy Johnson
Lafayette County
Health Dept
David Kelly
Area Agency on Aging Pine Bluff
of Southeast Arkansas
Gail Kyle
Woodruff County
Nursing Home
Bobbie Lewis
Convalescent Home Clarksville
Rebecca Lloyd
Arkansas Department Blytheville
of Health
Nancy Meneley
Baptist Hospital
Little Rock
Becky Messenger
Carol Mitchell
Diane Morgan
Vickey Greco
Kay Newton
Elizabeth Owens
Kathy Phelps
Christine Phillips
Lori Ratliff
Sherry Rickard
Janet Riepenhuff
Ella Romine
Marnie Roy
Richard Savage
Chyral Sims
Sabrina Spalding
Michael Springer
Patrick Stage
Arkansas Hospice
Little Rock
Delta Memorial
Home Health
Central Arkansas
Little Rock
Veterans Healthcare System
St. Bernard’s
Medical Center
Lincoln County
Star City
Millcreek of Arkansas Fordyce
Hembree Cancer
Fort Smith
Jeffeson Regional
Pine Bluff
Medical Center
Area Agency on Aging Pine Bluff
of Southeast Arkansas
St. Bernard’s
Medical Center
Conway Regional
Medical Center
Arkansas County
De Witt
Home Care
Northwest Medical
Bradley County
Medical Center
Saint Mary’s Regional Russellville
Medical Center
Veterans Hospital
Little Rock
Little Rock Cardiology Little Rock
Carrie Stark
Henderson State
Debbie Stewart
Cave City Nursing Home Cave City
Janet Thornton
Arkansas School for Hot Springs
Mathematics, Sciences & Arts
Faye Tompkins
Hillcrest Care &
Rehabilitation Center
Claudia Kay Turner Crittenden Regional West
Joyce Vest
Area Agency on Aging Pine Bluff
of Southeast Arkansas
Melissa Vidal
St. Vincent Infirmary Little Rock
Medical Center
Patsy Wald
Cindy White
Area Agency on Aging Pine Bluff
of Southeast Arkansas
Betty Wood
Dr. Franklin Roberts Magnolia
Family Practice
Beverly Young
Dr. Pennington
Family Practice
Spring 2008 I Arkansas Hospitals
IRS Approves Revised 990,
Schedule H
The Internal Revenue Service
(IRS) has released its final revised
Form 990 and 16 related Schedules,
including a new Schedule H for
Agreeing with the sentiment
expressed by 307 members of
the House of Representatives, the
American Hospital Association
(AHA) and an overwhelming majority of hospitals that filed comments,
the IRS decided to include the reporting of Medicare underpayment and
patient bad debt as a community
benefit on the new hospital Schedule
and granted a one-year transition,
making the form applicable for tax
year 2009 instead of 2008.
Including the underpayments (and
allowing additional space for hospitals to calculate and describe the full
value of their programs and activities) should promote greater transparency and community accountability.
The IRS also eliminated from the
form some burdensome questions
that were unrelated to community
benefit, particularly the chart labeled
“Billing Information.” Some hospitals had commented that providing
the information requested would
require 1,000 or more hours of staff
work. Eliminating that burdensome
chart was the centerpiece of the
House members’ and AHA’s letters
to IRS.
The tax agency did not, however,
release with the revised Schedule H
either the instructions or worksheets
that hospitals will need to complete
it. The AHA will continue to work
with IRS on these instructions and
worksheets and will monitor hospitals’ progress in collecting and
reporting the required information.
It will advocate for more time if IRS
delays encumber hospitals’ ability
to respond with complete and accurate information.
The biggest disappointment is
IRS’ failure to make questions on
joint ventures applicable to the
entire tax-exempt sector. Unlike
other parts of the tax-exempt sector
that joint venture with physicians,
hospitals are already regulated by
several different agencies.
Instead, IRS chose to require only
hospitals to answer questions on
joint ventures on multiple forms,
unnecessarily increasing their filing
What to Do Now
“In the face of this uncertainty,
the most productive steps taxexempt hospitals can take to
be ready for reporting are: to
review their charity care, billing,
and collection policies to be sure
they are up-to-date; to continue
efforts to identify and document
charity care that would otherwise
be in bad debt; and to review
their internal community benefit
reporting procedures to make
sure that they are getting as
much information as possible.”
Elizabeth M. Mills, McDermott,
Will & Emery, LLP
burden and thereby undermining
IRS’ own goal to lessen such burdens.
The revised IRS forms and
background materials are available at
Look for Hospital Spending to Double
by 2017, CMS Says
In a report soon to be released,
the Centers for Medicare &
Medicaid Services (CMS) estimates
that hospital spending will double
by 2017, totaling more than $1.3
trillion and making up about a
third of all healthcare spending.
The information will be released
online by the journal Health Affairs
Spring 2008 I Arkansas Hospitals
The report also shows that in
2007, healthcare spending overall
in the nation is estimated to have
grown by 6.7 percent to $2.2 trillion, and projections show that
rate is expected to hold nearly
steady over the next 10 years,
to 2017. That figure will represent about 20 percent of the
nation’s GDP (the monetary value
of goods and services produced in
the US).
In addition, the 2007 rate of hospital spending is estimated to have
grown by 7.5 percent to $696.7 billion,
up 0.4 percentage points from 2006.
The report also projects growth in
Medicare spending over the next 10
years, as baby boomers age and enter
eligibility for Medicare coverage.
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Spring 2008 I Arkansas Hospitals
Disruptive Board Members:
How to Work with Them
by Barry S. Bader, Edward A. Kazemek, and Roger W. Witalis, FACHE
“How do you deal with a board
member who dominates most discussions – just never stops talking?”
“What do you do when a board
member regularly ignores the agenda
and forces discussion on extraneous
“What can you do with a board
member who can be quite offensive in
the way he speaks to or attacks some of
the other members?”
“What should we do about board
members who miss more meetings
than they attend, don’t come prepared,
or arrive late and leave early?”
These are some of the most common
questions we get from board chairs
and CEOs that we meet in our work.
The board members who exhibit these
behaviors are a real challenge for the
board and the chairperson. They can
and often do have a negative impact
on the board’s overall effectiveness and
efficiency. Far too many board members just grin and bear it or vent their
frustrations in private after the board
The first thing to remember is any
behavior that interferes significantly
with the effective and efficient process of governance should be considered “disruptive” and treated as a
matter requiring immediate attention.
However, it is also advisable to spend
a little time analyzing possible causes
for the undesirable behavior of some
board members before taking action.
It’s useful to keep in mind that it
is rare for a board member to come
to a meeting with a personal goal to
disrupt the meeting. For instance, the
domineering board member may feel
very passionate about his/her ideas and
want to make sure others accept his/her
perspectives. The member who strays
from the agenda may feel that certain
issues can’t wait until a future meeting
or isn’t aware that there are procedures
for adding items to the agenda ahead
of time.
Spring 2008 I Arkansas Hospitals
The member who has an offputting or aggressive communication style may be exhibiting normal
behavior expected in his/her work
environment and feel that being
forceful and direct is what board
members are supposed to do.
Those who are chronic absentees, don’t prepare, or come late
and leave early may be overloaded with other responsibilities and
haven’t faced the fact that they can’t
meet the demands of being a board
Attempting to understand the reasons behind some board members’
behavior usually goes a long way
toward figuring out how to modify the
behavior. Figuring out how best to deal
with disruptive behavior usually falls
on the shoulders of the board chair
or the chair of the governance committee, with appropriate support from
the CEO and other board members.
Providing one-on-one, honest, timely,
board member (sometimes more than
once) is the most impactful approach to
bring about the desired change.
Of course, this is easier said than
done. Therefore, it’s useful to put some
“preventive measures” in place to reduce
the number of times these uncomfortable conversations have to take place.
Preventive Measures
1. Engage the full board in the
development of a “code of conduct”
for board member behavior and participation in meetings. Encourage
everyone to enforce the code’s guidelines during meetings and, periodically, check in at the end of board
meetings on how well the guidelines
are being followed.
2. During the recruitment process,
make sure that board member candidates understand and agree to the
board’s code of conduct.
3. Incorporate the code-of-conduct guidelines into the annual board
self-assessment discussion to hold
the board accountable for following
them. Also, consider some form of
individual board member evaluation
as part of the board self-assessment
and use that information to counsel
disruptive members. This can dramatically reduce disruptive behavior
going forward.
4. Educate board members on constructive ways to raise issues, monitor
processes, influence the board agenda,
and question policies vs. personalities.
5. Distribute the meeting agenda at
least a week before the meeting and
make sure it spells out clearly the subjects to be covered and the time allotted for each item. Leave some time for
discussion on other issues/concerns on
the minds of board members.
Finally, on those rare occasions when
nothing seems to work in modifying the
disruptive behavior of a board member,
ask the individual to leave the board.
This may seem harsh, but remember –
the overall effectiveness and efficiency
of the board comes first.
Reprinted with permission from
The Governance Institute. Provided
by Bader & Associates and www.
2008 HHS Federal Poverty Guidelines
The newest update to the
Department of Health and Human
Services (HHS) poverty guidelines
was published in the Federal Register
in January. The guidelines are used as
an eligibility criterion for many fed-
eral programs that HHS administers.
For more information regarding the 2008 poverty guideline,
please visit
A copy of the Federal Register
Notice is available on the National
Archives Web site (NARA)
net/7/257/2422/01jan20081800/ 256.pdf.
Blue Cross Promotes Executives
The Arkansas Blue Cross & Blue
Shield (ABCBS) Board of Directors
has named P. Mark White as chief
executive officer-elect and Michael
W. Brown as chief operating officerelect. Both will assume their respective roles on January 1, 2009.
In announcing the appointments, Blue Cross chairman Hayes
McClerkin said, “This announcement coincides with the established
retirement date for Sharon Allen,
current president and COO, on
January 29 [this year] and the
planned retirement of Robert
L. Shoptaw, CEO, at the end of
2008.” Both Allen and Shoptaw
announced their plans for retirement to the board three years ago.
Upon his retirement, Shoptaw
will assume the position of chairman of the board, succeeding
McClerkin, who has served as chairman since 1997. The ABCBS board
also announced that McClerkin
will become chair of the board’s
executive committee on January 1,
White and Brown are longtime
employees of ABCBS. White, who
joined the company in 1970, has
served as executive vice president
and chief financial officer since
1994. Brown has been executive
vice president of external operations since 2006. He has been with
ABCBS since 1974 and has held
numerous positions during that
2006 Health Spending Eases
The federal Centers for Medicare
& Medicaid Services (CMS) reported recently that U.S. healthcare
spending reached a total of $2.1
trillion in 2006 (the latest year for
which figures have been compiled),
but the growth rate was the slowest
since 1999.
Overall spending on healthcare
increased 6.7 percent in 2006, compared to 6.5 percent in 2005.
However, it continued to outpace overall economic growth and
general inflation, which grew 6.1
percent and 3.2 percent, respectively, in 2006.
The health spending share of the
nation’s Gross Domestic Product
(GDP) remained relatively stable in
2006 at 16.0 percent, up by only
0.1 percentage point from 2005.
At the aggregate level in 2006,
businesses, households, other private sponsors and governments
paid for about the same share of
health services and supplies as they
did in 2005.
However, spending shifts did
occur within major sponsor categories due to implementation
of the Medicare Part D benefit.
Medicare’s share of federal spending increased from 29 percent in
2005 to 34 percent in 2006, while
Medicaid’s share decreased from
45 percent to 40 percent.
declined for the first time since
the program’s inception, falling 0.9
percent in 2006. The introduction
of Medicare Part D, which shifted
drug coverage for dual eligibles
from Medicaid into Medicare, contributed to the decline in Medicaid
spending growth. Other reasons for
the decline include continued cost
containment efforts by states and
slower enrollment growth due to
more restrictive eligibility criteria
and a stronger economy.
Hospital spending grew 7.0 percent in 2006, a decrease of 0.3
percentage points from 2005 and a
continued deceleration from 2002
(when growth was 8.2 percent).
The 2006 growth rate was partially driven by lower utilization of
hospital services, especially within
Medicare as fee-for-service inpatient hospital admissions declined.
Spending for physician and clinical services slowed to 5.9 percent
in 2006 due to a deceleration in
price growth fueled by a near
freeze on Medicare payments to
physicians (whose fee schedule
update was 0.2 percent in 2006)
that influenced private payers as
The healthcare spending data
can be found on the CMS Web
site at
h t t p : / / w w w. c m s . h h s . g o v /
Spring 2008 I Arkansas Hospitals
by Elisa M. White, Vice President and General Counsel, Arkansas Hospital Association
Legal Note:
Physician On-Call Coverage
In 2007, the Department of
Health and Human Services Office
of Inspector General (OIG) issued
Advisory Opinion No. 07-10 approving a nonprofit hospital’s arrangement to pay physicians for providing
on-call coverage and indigent care
However, this Opinion is far from
a stamp of approval for on-call pay
arrangements. In the Opinion, the
OIG warned that compensating physicians for providing on-call coverage can create “considerable risk” of
improper remuneration in violation
of the Anti-Kickback Statute.
The Anti-Kickback Statute makes
it a criminal offense to knowingly
and willfully offer, pay, solicit, or
receive any remuneration to induce
or reward referrals of items or services
reimbursable by a federal healthcare
program. For purposes of the statute,
“remuneration” includes the transfer
of anything of value, directly or indirectly, overtly or covertly, in cash or
in kind.
Because hospitals face substantial
civil and criminal penalties for violation of the Anti-Kickback Statute
and other fraud and abuse laws, they
should thoroughly evaluate the need
for an on-call payment arrangement,
and any such program should be carefully structured.
In Advisory Opinion No. 07-10,
the OIG found that although the
hospital’s compensation arrangement
had the potential to generate remuneration prohibited under the federal
Anti-Kickback Statute, it would not
impose sanctions due to the arrangements’ structure and operation. While
this Opinion, like all advisory opinions, is legally binding only on the
requesting parties, it provides guidance for evaluating the Anti-Kickback
Statute risk of a call pay arrangement.
The hospital that obtained the
Opinion is a nonprofit, tax-exempt
institution with an emergency depart26
Spring 2008 I Arkansas Hospitals
ment that accepts all patients regardless
of their ability to pay. Approximately
25 percent of the hospital’s emergency department patients are uninsured, with 1 in 10 of the uninsured
emergency department patients subsequently admitted to the facility.
A lack of available physicians to
provide call coverage had compromised the hospital’s ability to meet
community needs for emergency services. In an effort to address this
problem, the hospital instituted an
arrangement under which physicians
on its Medical Staff in certain specialties receive per diem payments for participating in a call rotation schedule,
responding promptly to emergency
department calls, and providing inpatient care to emergency department
patients admitted to the hospital until
their proper discharge and regardless
of their ability to pay.
The OIG noted that it may be possible to structure an on-call arrangement to meet the personal services safe
harbor, but many of these arrangements, including the one described in
this Opinion, fail to fit into this safe
harbor because aggregate compensation is not set in advance. Failure to
meet an Anti-Kickback Statute safe
harbor does not render an arrangement illegal; instead, the OIG will
The OIG concluded the Opinion
with a final warning that “on-call
coverage compensation
should be scrutinized closely to
ensure that it is not a vehicle to
disguise payments for referrals.”
take into account all of the facts and
circumstances in determining whether an Anti-Kickback violation has
According to the Opinion, the key
inquiry in analyzing on-call and indigent care payment arrangements is
whether the compensation is: (i) fair
market value in an arm’s-length transaction for actual and necessary items
or services; and (ii) not determined in
any manner that takes into account
the volume or value of referrals or
other business generated between the
The OIG found the compensation
arrangement in Advisory Opinion
No. 07-10 “presents a low risk of
fraud and abuse,” noting the following facts:
• The hospital certified that the payments under the arrangement were
consistent with fair market value
for the actual services needed and
were provided without regard to
referrals or other business between
the parties.
• Although different per diem rates
were paid for each specialty, the
rates varied based upon the different extent of the uncompensated
responsibilities that are likely to fall
on physicians in that specialty.
• Each physician was required to
provide 1½ days of uncompensated on-call coverage monthly.
• All physicians in a specialty were
paid the same per diem rate regardless of their referral patterns to the
• All Medical Staff physicians in a
given specialty were given the ability to participate.
• Monthly call obligations were distributed as evenly as possible.
• Physicians were required to see
each patient regardless of their
ability to pay.
• Prompt completion of medical
record documentation was a condition to continued payment under
the arrangement.
• An independent analysis by a reputable consultant concluded that
the compensation was fair market
value for the services furnished.
• All costs of the on-call/indigent
care payment arrangement were
paid by the hospital and not by a
federal healthcare program.
• Prior to entering into the arrangement, the emergency department
was understaffed and the emergency
care was being outsourced, so there
was proof that the hospital had a
legitimate unmet need for on-call
and indigent care services.
• Since inception of the arrangement,
the hospital has experienced greater
efficiency in the emergency department, improved on-call performance, and greater overall patient
In addition to listing helpful fac-
tors in the arrangement at issue, the
Opinion also noted certain problematic call payment structures, including
without limitation, “lost opportunity”
payments that do not reflect bona fide
lost income and compensation for
professional services for which the
physician receives separate reimbursement from insurers or patients.
The OIG concluded the Opinion
with a final warning that “on-call
coverage compensation should be
scrutinized closely to ensure that it is
not a vehicle to disguise payments for
Advisory Opinion No. 07-10
can be accessed through the OIG
Web site at
Suggested topics for the Legal
Note may be submitted to [email protected].
Legal Note is provided solely for
informational purpose and does not
constitute legal advice. Readers are
encouraged to consult with their
own attorneys about any legal
issues, including those discussed in
this article.
Will Older Physicians Opt Out of Patient Care?
by Kurt Mosley
New Survey Sounds Warning
What would happen if physicians
age 50 or older suddenly decided to
turn in their stethoscopes?
Given the sheer number of physicians in this age cohort, the results
would be disturbing, to say the least.
According to the American Medical
Association (AMA), 47 percent of all
doctors in the U.S. – some 387,160
physicians – are 50 or above. Of
the 4,097 physicians in Arkansas
who are active in patient care, 1,700
(41 percent) are over 50. Clearly,
any exodus of older physicians from
medicine would incapacitate our current healthcare delivery system, both
nationally and in the Natural State.
While no such immediate exodus
is anticipated, the aging of the physician population is cause for concern.
Merritt, Hawkins & Associates tracks
the concerns and career plans of older
physicians through our Survey of
Physicians 50 to 65 Years Old. The
2007 Survey was recently released
and reveals some interesting findings.
Fourteen percent of the 1,175 physicians we surveyed plan to retire in
the next one to three years. Another
seven percent plan to find a medical
job in a non-clinical setting, while
three percent plan to find a job in a
non-medical setting. In all, about
one-quarter of doctors surveyed said
they plan to opt out of patient care
sometime in the next one to three
years. In addition, 12 percent said
they plan to work part-time (20 hours
a week or less), eight percent plan to
significantly reduce their workload
and four percent plan to work locum
People do not always do what they
say they will in surveys. Nevertheless,
these numbers are sobering. Should
only ten percent of older physicians
retire or opt out of patient care in
the next one to three years, tens
of thousands of doctors would be
removed from the national physician
work force, and Arkansas could be
severely impacted. Should an additional ten percent choose to work
part-time or slow down significantly
in the next one to three years, many
additional FTEs would be lost. At
that point, the number of exits from
medicine would exceed the number
of entrants.
Given that the U.S. already is
experiencing a physician shortage in
many areas, a significant reduction
in the number of older physicians in
the near future would be particularly
inopportune. Consider that virtually
all of the major presidential candidates support health policies that
would extend healthcare access to
millions of people who lack such
access now. The enhanced demand
for medical services would tax the
current physician workforce and very
likely would overburden a workforce
diminished by retirement and other
forms of attrition.
Though this fact often seems to fly
under the radar, health policies must
be implemented by people, and any
policy that expands access without
also expanding the supply of physicians, nurses and other health professionals will most likely fall short
of expectations. By extension, any
plan that causes a significant number of older doctors to walk away
from their patient career also will be
unlikely to succeed.
A copy of Merritt, Hawkins &
Associates’ 2007 Survey of Physicians
50 to 65 Years Old is available at
Kurt Mosley is vice president of
business development for Merritt,
Hawkins & Associates, a physician
search firm and a division of AMN
Healthcare, the largest healthcare
staffing company in the United
States. He can be reached at [email protected] or you may call
him at (800) 876-0500.
Spring 2008 I Arkansas Hospitals
Action Ideas for Increasing staff
Participation at Meetings
by Susan Keane Baker
Oh no. It’s time again for the
dreaded staff meeting. You’ve
worked on the agenda, you’ve
estimated how much time each
discussion item should take,
and you’ve even brought in
donuts. And you know that
some of your colleagues are
going to sit there stone-faced
throughout the meeting.
What are they thinking?
That they could be getting
their real work done if not
for these meetings you insist
on having? Are they replaying
last night’s episode of Law
and Order in their minds?
Or have they, unbeknownst
to you, mastered the skill of
sleeping with their eyes open?
Something needs to be done!
Encouraging greater staff
participation is risky, because
it means giving up some of
your control, but your meetings will be more relevant and
better learning experiences for
everyone – including you. To
increase participation at meetings, consider the following
1. Give your listeners a reason to care by taking time to
explain why the subject being
addressed is important. And
be excited yourself about the
topic and the meeting.
Don’t serve donuts every
time – create some anticipation by providing interesting
Spring 2008 I Arkansas Hospitals
refreshments. If your local
newspaper or magazine publishes a “best of” column,
purchase the items there and
bring it in along with the
article. “Here is the best coffee
cake in the city, according to
the Boston Globe.”
2. Make it easy for staff to
contribute agenda items whenever it occurs to them. At Dr.
Paul Quartararo’s practice in
Stamford, Connecticut, a box
marked “Agenda Items for
Staff Meeting” was conspicuously visible at the registration
area. As patients raised questions or concerns, staff members could jot a quick note
and toss it into the box. This
was far more effective than
someone asking before each
meeting: “Anything you want
to talk about at the staff meeting?” The typical response had
been, “Oh yeah, there was
something, but now I forget
what it was.”
3. Elton Mayo wrote: “The
extent to which we do or do
not fully contribute is governed more by attitude than
necessity, fear or economic
influences.” You can change
attitudes by letting your staff
become the experts by involving them in some advance
research. Ask them to contact
colleagues at two other orga-
nizations to see how an issue
is being addressed.
When patient-related issues
arise, ask them to take on the
role of the patient. One manager purchased ear mufflers
and asked for volunteers to
wear them around their home
for a weekend (to simulate
and understand being hard of
hearing). The employees found
that they began to agree with
statements without understanding them and started to
give any answer rather than
saying – for the ninth time
– “What did you say?” The
reports of their experiences
made for lively conversation
at the staff meeting, with the
result that all staff members
were alerted to speak more
slowly, repeat their questions,
and even write down questions
when they received a nonsensical reply from a patient.
4. Hold a dress rehearsal.
Ask staff members for their
ideas in one-on-one discussions. When you hear something that would benefit everyone, ask the person to state
their thoughts again when
the group meets. If someone
expresses fear about speaking in front of the group, ask
permission to quote them in
the meeting. “When Frank and
I spoke about this, he mentioned ...”
5. Place staff members’ names on
the agenda as co-presenters. A new
policy is listed as being discussed by
a physician leader and a staff person,
for example. Both should be aware
of this of course. The physician and
staff member should have a conversation ahead of time during which
the physician reviews the policy and
the staff member plans the reaction.
The staff member’s role can be to
co-present the information or be the
first to respond with questions or
6. Present the information in different ways. Tie the topic to something
you read in the newspaper. In a January
2001 Training and Development article titled “Ten Steps to Being Positively
Engaging,” Basil Deming suggested
that meeting participants be asked to
paraphrase or explain what has just
been said. If they can’t do it after hearing it, they can’t be expected to do it
later, such as back on the job.
Deming recommended vignettes,
case studies, role play or simulations as
techniques that can take information
from dull and dry to dynamic and relevant. Ask participants to recap what
is already known before delving into
the new material. Deming’s example:
“Last week, we learned from Human
Resources that there are two types
of adverse actions. What are they?”
(Reply) “Yes, performance based and
conduct based actions. What does
the term performance-based action
mean?” (Reply) “Yes, the problem
lies in a person’s performance of job
duties, for example, repeatedly failing
to meet reasonable work deadlines.
This morning, we’re going to take
a closer look at performance-based
7. When a staff member makes a
presentation, take the time to send
a personal note of thanks. This will
inspire future contributions. I once
worked with a Vice President of
Nursing, Terry Roderick. Whenever I
made a presentation for the hospital’s
board of directors, Terry would send
me a handwritten note afterwards
telling me what she liked about my
presentation. At one point, I wrote
back to her: “Terry, I have to do a
good job – because I want you to send
me a note!”
8. Ask for advice from those who
attend. “What could we do to make
the staff meetings more interactive?”
Commit to trying the ideas you hear.
The participation you create
through these techniques will mean
that no one will be sleeping at your
Copied with permission of the
author, Susan Keane Baker. Source:
Editor’s Note:
The Arkansas Hospital Association
is proud to announce that Susan Keane
Baker will offer a leadership workshop on “Exceptional Patient Care”
October 8 as part of our new Annual
Meeting schedule. Watch your mailbox for upcoming information about
the AHA’s 78th Annual Meeting and
Trade Show October 8-10 in Little
Spring 2008 I Arkansas Hospitals
Arkansas PAC Contributions
During 2007, the Arkansas
Hospital Association Political Action
Committee (AHAPAC) received
$21,334.50 in contributions, primarily from hospital executives and
employees throughout the state.
These donations, which are shared
between the Arkansas Hospital
Association and the American
Hospital Association, make possible
the financial support those organizations are able to provide to political
candidates seeking state or federal
elective offices.
Contributions of any amount from
all contributors to the AHAPAC are
seriously needed and deeply appreciated. However, special acknowledgement is given to individuals
who contribute at certain threshold levels. Those individuals qualify
for recognition as members of the
American Hospital Association’s Ben
Franklin Club, Chairman’s Circle or
its Capitol Club.
Ben Franklin Club membership
is awarded for individuals who
contributed $1,000 or more to
Ben Franklin Club:
Phil Matthews, Arkansas Hospital Association
Bo Ryall, Arkansas Hospital Association
Chairman’s Circle:
Don Adams, Arkansas Hospital Association
Jonathan R. Bates, M.D., Arkansas Children’s
Bill Bradley, Washington Regional Medical System
Roger Busfield, Arkansas Hospital Association,
David Cicero, Ouachita County Medical Center
Tina Creel, AHA Services, Inc.
Paul Cunningham, Arkansas Hospital Association
Dean Davenport, BKD, LLP, Retired
Bob Gant, Conway Regional Medical Center
John A. Guest
Russell D. Harrington, Jr., Baptist Health
Michael D. Helm, Sparks Health System, Retired
Timothy E. Hill, North Arkansas Regional Medical
Beth Ingram, Arkansas Hospital Association
Luther J. Lewis, Medical Center of South Arkansas
Penny McClain, Siloam Springs Memorial Hospital
Raymond W. Montgomery, II, White County
Medical Center
John Neal
Scott Peek, Chambers Memorial Hospital
Ron Peterson, Baxter Regional Medical Center
Ronald K. Rooney, Arkansas Methodist Medical
Stephen C. Smart, Medical Center of South
Spring 2008 I Arkansas Hospitals
AHAPAC. Chairman’s Circle membership is awarded for individuals
who contributed $500 or more to
AHAPAC during the year, while the
Capitol Club membership is earned
with a $250 donation.
Individuals from Arkansas who
qualified for membership in each
of these clubs in 2007 are shown
Douglas Weeks, Baptist Health Medical CenterLittle Rock
Elisa White, Arkansas Hospital Association
Ted Woodrell, Sparks Health System
Capitol Club:
Robert P. Atkinson, Jefferson Regional Medical
Robert R. Bash
Gary L. Bebow, White River Health System
Vincent B. DiFranco
Richard L. Goddard, Monticello
Edward L. Lacy, Baptist Health Medical CenterHeber Springs
Mark Lowman, Baptist Health
James L. Magee, Piggott Community Hospital
Mike McCoy, Saint Mary’s Regional Medical
Larry Morse, Johnson Regional Medical Center
Ben E. Owens, St. Bernards Healthcare
Barry Pipkin, Universal Health Services
Herbert K. Reamey, III, Ozark Health Medical
Diane Roberts, North Arkansas Regional Medical
Nancy Robertson, Robertson Cook Communications,
Allen F. Smith, Baptist Health
Rosiland Smith, Arkansas Children’s Hospital
Russ D. Sword, Ashley County Medical Center
John Tucker, Five Rivers Medical Center
Save the Date! May 22, 2008
Hot Springs Convention Center - Hot Springs, AR
Health Care Quality: The Future is Connected
atient care. It’s about more than one facility,
or one clinic. It’s about connection....between
providers, patients, and the entire health care
community. Join us this May to learn innovative,
creative new ways to improve health care across the
state through “connections in care.”
Find out more:
This material was prepared by the Arkansas Foundation for Medical Care Inc. (AFMC), the Medicare Quality Improvement Organization for Arkansas, under contracts with the Centers for Medicare & Medicaid Services
(CMS), an agency of the U.S. Department of Health and Human Services, and the Arkansas Department of Human Services, Division of Medical Services. The contents presented do not necessarily reflect CMS and
Arkansas DHS policies. The Arkansas Department of Human Services is in compliance with Titles VI and VII of the Civil Rights Act.
Spring 2008 I Arkansas Hospitals
by Paul Cunningham, Senior Vice President, Arkansas Hospital Association
Hospitals Urged to Provide Patients
with ACASA Materials
Hospital emergency rooms are
places where people tend to show
up in pretty dire conditions following traumatic injury. Face-to-face
encounters between doctors, nurses
(and other hospital ER workers) and
patients who have survived some
type of horrific traumatic episode
are as common as the miracles that
spring from the care and assistance
those healthcare professionals render.
Those miracles don’t just happen,
they’re the byproduct of ER teams
who not only are experts at repairing
bodies, but also are ready, willing,
able and committed to making sure
everything that can be done to fully
restore patients’ minds and spirits to a
pre-trauma state is done.
That mind-set applies to all victims
of trauma, whether they happen to be
suffering the aftereffects of automobile accidents, gunshot wounds, fires
and falls, which are all too common,
or if they are victims of another type
of trauma, one that occurs too often
yet is mentioned less frequently.
They’re the victims of sexual
assault, one of the most traumatic
experiences a person can endure.
A few years ago, the U.S. Department
of Justice (DOJ) published statistics
showing that 1.3 women are raped in
the U.S. every minute. That translates
to 78 rapes per hour, 1,871 per day,
5,619 per month and 683,000 per
year. Those facts are a little dated,
so the actual numbers are probably
greater, and they don’t include sexual
assaults against men. Plus, they reflect
only the reported rapes. A big majority go unreported.
Chances are that a victim of a
reported rape will get medical treat32
Spring 2008 I Arkansas Hospitals
ment. Most do, and they tend to get
it in a hospital ER, which makes those
patient encounters much more prevalent than you might expect. In fact,
the DOJ says that sexual assault is
the fourth leading cause of violencerelated non-fatal injuries treated in
hospital ERs.
But these ER patients are treated
a bit differently than others. When
a sexual assault victim presents to
a hospital ER, the medical staff first
assesses and responds to any serious
or life-threatening injuries, as they do
for all ER patients. However, after the
patient is stabilized, treated and readied for release, transfer or admission,
there might also be a formal evidentiary examination, depending on the
patient’s consent, the applicability of
state laws and the judgment of law
enforcement officials or prosecutors
as to whether an examination will be
useful and can be justified.
Beyond the immediate care, some
hospitals employ certified Sexual
Abuse Nurse Examiners (SANE), nurses who are specially trained to care for
sexual assault victims, and a few have
SANE programs that focus on counseling patients about needs that extend
beyond the initial care, like referral to
a private physician for follow-up case
care, counseling services and other
providers in the community.
Fortunately, there’s now one more
step that all the state’s hospitals can
take to make things a little easier for
the sexual assault victims who come
to them needing care.
The Arkansas Coalition Against
Sexual Assault (ACASA) recently
contacted the Arkansas Hospital
Association about assistance with
making information readily avail-
able to better inform victims of sexual assault of their rights. ACASA has
received a grant from DOJ for that
purpose and is working primarily with
police agencies throughout the state
on this effort.
However, because so many sexual
assault victims are treated in hospital
ERs, the group also has requested
the hospitals’ assistance in the form
of posting materials in their ERs and
distributing informational cards to
victims who are treated there.
The materials include a poster
holding tear-off slips, both of which
contain a listing of victims’ rights,
such as the availability of assistance,
including medical, housing, counseling, financial, social, legal and emergency services; eligibility for compensation under the Arkansas Crime
Victims Reparations Act; protection of
the victim, including protective court
orders; and access to public records
related to the case.
The AHA board heard about the
request during its January 11 meeting and quickly approved a motion
to encourage all member hospitals
to assist. ACASA will soon be contacting hospital CEOs and providing the materials.
Cooperating by helping to get
this information into the hands of
sexual assault victims sounds like a
small thing, but it could open some
doors that will allow more victims to make their own miraculous
recovery from effects of this senseless, violent, brutal crime which
could otherwise stay with them for
a lifetime.
For more information, go to
Many Labor-Related Resources Available
from American Hospital Association
The current edition of the
want to download a recent release
attempt to pressure a targeted
American Hospital Association’s
titled Corporate Campaigns: Five
hospital or health system to
publication Health Care Labor
Questions Every Hospital Leader
expedite an organizing campaign
Report may be of particular interShould Ask to Prepare for and
by means of a “card check”
est to hospital governance board
Manage a Corporate Campaign.
or similar process, instead of a
members, as they seek to stay
This eight-page resource was
private ballot election. Often,
on top of labor activities,
the unusually aggressive
trends and events affecting
tactics impede the abilhealthcare. The publicaity of a hospital to serve
tion provides updates on
the short and long-term
Labor activity, trends & events
the latest regulatory, legneeds of its patients or
islative and marketplace
developments, including
The resource is for
important findings from
AHA members, and it
Five Questions
National Labor Relations
assesses whether a hospiEvery Hospital Leader Should Ask
Board (NLRB) statistics
tal is vulnerable to a camto Prepare For and Manage
a Corporate Campaign
and other survey data.
paign and what its parThe
ticular vulnerabilities are,
produced jointly with
including its relationships
with community leaders
human resources perand institutions.
sonal membership group, and
prepared for the AHA by F. Curt
The resource also offers guidIRI Consultants to Management,
Kirschner, Jr., a partner in the
ance about how a hospital can
San Francisco office of the law
respond to a corporate campaign,
When you look for the curfirm of O’Melveny & Myers. It
including possible lawsuits, if a
rent issue of the newsletter at
examines “five questions every
union engages in unlawful activithe AHA’s Web site, www.aha.
hospital leader should ask” in
ties. It may prove particularly
org, also have a look at other
preparing for and responding to
helpful for hospital trustees who
resources designed to help hospia corporate campaign.
want to understand and prepare
tals address employee workplace
Corporate campaigns are a
their hospitals for union corpoissues. For example, you might
union’s public, multi-faceted
rate campaigns.
11:53 AM
Page 1
he AHA on January
16 filed an amicus
brief in Chamber of
Commerce v. Brown, a U.S.
Supreme Court case that
is attempting to overturn
a California law forbidding employers to use any
state funds to influence
employees about whether
to select a union as their
bargaining representative.
Hospitals, the AHA’s brief
points out, are at the center
of the case’s employer free
speech controversy because
they rely on Medicaid dollars and other state funding
programs and are frequent
subjects of union organizing drives.
“When hospitals are deterred by the state from
communicating to their employees about the appropriate hospital-employee relationships within
their community,” the brief concludes, “it is not
just the hospitals that are adversely affected. The
employees who lack the information necessary to
make a fully informed choice also are harmed.” A
copy of the AHA’s amicus brief in the case can be
found on the AHA’s Web site at http://www.aha.
Legal proceedings to overturn the CA law,
AB 1889, were initiated in 2002 by the U.S. and
California Chambers of Commerce, California
Hospital Association, several other associations
and specific employers. These groups argue,
Nurse staffing ratios are “the only safe staffing
solution for nurses and patients” declares a
California Nurses Association/National Nurses
Organizing Committee (CNA/NNOC) marketing brochure. The CNA/NNOC recently
launched a direct mail campaign to gain support among nurses for the union’s efforts to
organize and enact mandated staffing ratios
legislation around the country. As the brochure
explains, “The California law has brought
renewed hope and energy to all RNs. RNs
across the nation have seen the future – and
they know it works.” Hospitals will want to
be familiar with the CNA/NNOC organizing
and advocacy efforts and pay attention to the
rhetoric used as they get actively involved in
the staffing ratios debate.
among other things, that the law is preempted by
the National Labor Relations Act (NLRA) “because it regulates noncoercive employer speech
that Congress specifically intended to protect by
leaving it free from governmental regulation.”
The NLRA protects and encourages noncoercive employer speech about union organizing so
that employees may make an informed decision in
exercising their NLRA right to join or refrain from
joining a union. As the groups argue in their brief,
“[u]nder settled preemption principles, California’s
backdoor effort to alter supreme federal labor
policy cannot stand.” Any other outcome, the brief
concludes, would allow for the “balkanization of
The brochure specifically attacks “hospital industry rhetoric” arguing that nurse staffing ratios in
California are a “floor, not a ceiling – and not a substitute for acuity.” CNA/NNOC also suggests that “no
hospitals have closed due to the ratios.” According
to the brochure, when challenged by a judge, “the
hospitals were unable to produce any evidence” to
support the claim that hospitals have had to close as a
result of the staffing ratios mandate.
The brochure targets nurses with “what you can
do with NNOC/CNA to bring ratios to your state.”
In the brochure, CNA/NNOC reports that nurse
staffing ratio bills similar to California’s “are being
introduced” in Arizona, Illinois, Maine, Ohio, and
Texas and that RNs in other states “are also actively
working to enact mandated ratios.” The brochure
includes a detachable response card that nurses can
return to become a member of CNA/NNOC or for
Continued: See OVERTURNING, Page 2
Continued: See RATIOS, Page 4
Government Collects $2.2B in Settlements,
Judgments in Fiscal Year 2006
During fiscal year 2006, the federal government won or negotiated
approximately $2.2 billion in judgments and settlements, according to
the Health Care Fraud and Abuse
Control Program’s (HCFAC) annual report released by the OIG.
Approximately $1.5 billion was
transferred to the Medicare Trust
Fund as a result of these efforts. In
addition, $177.1 million in federal
Medicaid money was transferred
separately to the Treasury as a
result of these efforts. The HCFAC
account has returned more than
$10.4 billion to the Medicare Trust
Fund since the program began in
According to the report:
• U.S. Attorneys’ Offices opened
836 new criminal healthcare
fraud investigations
• Federal prosecutors had 1,677
healthcare fraud criminal investigations pending
• Criminal charges were filed in
355 cases
• A total of 547 defendants were
convicted for healthcare fraud
• The Department of Justice
opened 915 new civil healthcare fraud investigations and
had 2,016 civil healthcare
fraud investigations pending at
the end of the fiscal year.
Spring 2008 I Arkansas Hospitals
by Pam Brown, RN, BSN, CPHQ, and William E. Golden, M.D., MACP,
Arkansas Foundation for Medical Care
Benchmarking to High Performers
Drives Effective Improvement
In the late 1990s, national data ers are using a different standard not impact other parts of the
indicated that Arkansas hospitals to benchmark their performance. country. However, standards of
trailed national averages on many “Achievable Benchmark of Care,” care are not regionally defined
performance measures – but that developed by the University of within the United States. The
is no longer the case. Substantial Alabama at Birmingham, shows same standard of care is expecteffort was made to disseminate that identification of perfor- ed whether the hospital is in
clinical standards, as well as mance by providers in the top California, Utah, Iowa, New
the basic techniques in process 10 percent of measured facilities York or Arkansas.
change and quality improvement. gives an indication of achievThe Arkansas Foundation
Those activities paid off: aggre- able performance by a healthcare for Medical Care (AFMC) uses
gate performance by Arkansas facility. Thus, quality improve- the nationwide, top 10 percent
hospitals are rising from below ment initiatives develop a vision standard for benchmarking to
average and are coming closer to of performance beyond the aver- communicate performance to
achieving the national average on age, but to a level of excellence Arkansas hospitals. The recently
many indicators. However, as Ar- as defined by what has been completed Medicaid Inpatient
kansas facilities and clinics have achieved by other institutions.
gained comfort in clinical meaAt the state level, Arkansas pro- rewarded institutions for achievsurement and quality improve- viders seem motivated when they ing performance at Arkansas’
ment, it has become clear that are presented with blinded data 75th percentile for the previous
pursuit of average performance is that show their state rankings year. Many institutions respondnot sufficient to make long-term and also identify their relation- ed with strong internal qualmeaningful change.
ship to the state’s top 10 percent ity improvement initiatives to
Quality improvement activities in performance, since local peers achieve this benchmark through
originally focused on comparing often experience similar barriers redesign of their clinical prolocal compliance to
national guidelines for
clinical care. Rates of
performance for a particular provider were
compared to national,
state and, in some casPPS 90th PERCENTILE: 89.84%
es, county averages.
Outlier status tended
to focus on substantial
deviation from aver50.00%
age performance. But
too many “average”
clinical units nationwide simultaneously
engage in quality im0.00%
X2 X1 W2 W1 V2 V1 U2 U1 T2 T1 S2 S1 R2 R1 Q2 Q1 P2 P1 O2 O1 N2 N1 M2 M1 L2 L1 K2 K1 J2 J1 I2 I1 H1 G2 G1 F2 F1 E2 E1 D2 D1 C2 C1 B2 B1 A2 A1
provement measures;
Individual PPS hospital rates
thus, pursuing the
average is a prescription for continual lagging on the clinical performance to improvement. Similarly, when cesses. (Figure 1 displays blinded
national benchmarking first aggregate data by facility.)
began to be utilized, a defense
Choosing a higher
response to discount any gaps in Benchmarking challenges
performance usually focused on
One problem with a benchIncreasingly, Arkansas provid- regional influences that might mark approach can be the lack of
2006 Appropriate Care Measure (ACM) rates
for Prospective Payment System (PPS) Arkansas hospitals
Spring 2008 I Arkansas Hospitals
data for some important issues
in healthcare delivery. A lack
of benchmark data is especially problematic in performance
related to patient safety. It is
understandably difficult for an
institution to find meaningful comparative data on rates
of falls or other “avoidable”
events. It is hoped that the creation of regional Patient Safety
Organizations (PSOs) could protect the reporting of such data
but still allow organizations
to compare their efforts with
appropriate peer groups.
Another dilemma is that it
is often difficult to understand
what is being measured and the
source of the data. In Arkansas,
hospitals have made great progress in improving their performance in core measures specified
by the Centers for Medicare
& Medicaid Services (CMS),
which include acute myocardial infarction, heart
failure, pneumonia and the
surgical care improvement
project measures. As a state,
Arkansas has improved in
these measures, and several
providers are at or above
the national average. Yet,
reports released from other
organizations continue to
rank Arkansas as 48th in the
management of heart disease,
stroke and other measures.
Why does one report show
that Arkansas hospitals are
improving, while another indicates they are falling behind?
Often the data used differs,
including the components being
measured, time frame of the
data, and whether administrative or actual medical records
are assessed. In addition, some
rankings include only inpatient
information, while others look
at both inpatient and outpatient data. Some benchmarking
reports are based on patient
interviews, while others include
subjective and objective information.
Benchmarking uses
With a clear understanding
of what constitutes each benchmarking report, providers and
facilities can use these tools to
accelerate and guide performance. However, some organizations use benchmarking for
more than regulatory compliance:
• Benchmarking can be used
in strategic management – for
clinical excellence, as well as
business or marketing goals.
• Benchmark data drives many
of the payor incentive pro-
where health professionals can
share experiences and processes
that have led to breakthroughs
in clinical performance. Thus,
benchmarking can identify highperforming institutions that can
serve as models and resources
for other facilities. Subsequent
peer-to-peer networking can
promote sharing of best practices and advice obtained from
hands-on experience on how to
best support change in a clinical
When individual hospitals
show that they can reach higher
levels of performance, it fosters
a “can do” attitude and motivates others to ask, “How can
we achieve that level of performance?”
When individual hospitals show that they can reach
higher levels of performance, it fosters a “can do”
attitude and motivates others to ask, “How can we
achieve that level of performance?”
grams that roll out to the providers, where payments can
be based on whether providers achieve upper percentiles
in performance.
Ultimately, benchmark data
should guide models for improvement and not just be targets to
be achieved. Programs such as
the Collaborative Area Learning
Sessions (CALS), organized by
AFMC, can provide a forum
1. Kiefe CI, et al. Improving quality improvement using achievable benchmarks for physician feedback: A randomized
controlled trial. JAMA. 2001
June; 285(22): 2871-9.
2. Weissman
N W,
Achievable benchmarks of
care: the ABC™s of benchmarking. Journal of Evaluation
in Clinical Practice. 1999; 5(3):
Spring 2008 I Arkansas Hospitals
Healthcare CEO Survey Shows Financial
Challenges are Top Concern
Rising labor costs, bad debt and
other financial challenges are the current top concern of hospital CEOs,
according to a survey by the American
College of Healthcare Executives
(ACHE) released January 7.
Second on the list was providing care to the uninsured; third was
hospital-physician relationships.
According to survey results, worries about Medicaid funding and
coping with rising costs for both staff
and supplies tied as the top issues
contributing to CEOs’ financial worries.
The survey was conducted by
both phone and fax in the fall of
State Revises Death Certificate Form
The Arkansas Department of
Health (ADH) has notified the
Arkansas Hospital Association
that, effective January 1, 2008,
all certifications of deaths must
be completed on the new, revised
Death Certificate form provided by
the ADH, Vital Records Division.
The new pads of certificates
have been distributed to all County
Health Units and funeral directors.
The ADH is asking all hospitals that store blank pads (e.g. at
nursing stations, in the emergency
room, or in the HIM department),
to ensure that the current form is
replaced with the new form.
Pads may be ordered from
Vital Records County Registrars
in local County Health Units.
Questions should be directed to
Mike Adams, Vital Records State
Registrar (501) 661-2371, Grace
Carson, Assistant Director (501)
661-2275 or Steve Whisnant,
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Spring 2008 I Arkansas Hospitals
A d v o c A c y
Arkansas receives nDC Billing Extension
The Arkansas Medicaid program received notice December 31
that CMS has granted the state’s
request for an extension in meeting federal requirements to implement a new National Drug Code
(NDC) billing policy.
Medicaid program offi cials
filed for the extension after learning from the Arkansas Hospital
Association and hospital officials
that many of the state’s hospitals
could not be ready to comply with
the new policy to bill affected services using the appropriate drug
codes by the January 1 effective
date. Based on that information,
CMS granted a six-month delay,
until July 1, 2008, on implementing the policy for hospital claims.
Medicaid’s Official Notice of the
change, dated January 14, 2008,
states, “Effective for dates of service beginning July 1, 2008, providers billing an institutional outpatient claim electronically or billing a paper claim on the CMS-1450
(UB-04) must bill according to
the Official Notice dated October
24, 2007, Implementation of the
Federal Deficit Reduction Act of
2005, Requiring National Drug
Codes (NDC) When Billing Drug
Procedure Codes.”
The Official Notice can be
found on the Arkansas Medicaid
Web site at https://www.medicaid. under the Provider section.
The Deficit Reduction Act of
2005 required the submission
of NDCs, as well as appropriate
HCPC/CPT codes on Medicaid
claims containing drug procedure codes on the CMS-1500 and
UB-04 billing forms.
The purpose of the new requirement is to assure that the states
obtain a rebate from those manufacturers who have signed a rebate
agreement with the CMS.
Community match Physician
recruitment Program
The New Community Match
Physician Recruitment Program
was created by Arkansas state law
in an effort to attract more physicians to medically underserved
areas in the state. This program
is an excellent resource to assist
communities in physician recruitment efforts.
How does it work? The physician is required to commit four
years to practicing in a medically underserved community in
Arkansas in exchange for an extra
$20,000 per year for each year of
service for a maximum amount of
$80,000. Half of this is funded
by the community and the other
half is matched by the State. This
is a $10,000 per year commitment from the community and
a $10,000 per year commitment
from the State for a total of four
years. The funds are given to the
physician at the beginning of each
year of service.
What type of medicine must
the physician practice? The physician may practice one of the
following Primary Care specialties: Family Medicine, General
Internal Pediatrics, General
Pediatrics, General OB\GYN,
General Surgery, or Emergency
What physicians are eligible?
A bona fide resident of Arkansas
who is a graduate from an accredited medical school in the United
States and is currently enrolled
in a residency or other training
program in an area of Primary
Care, or completed training no
more than two years prior to
applying, is eligible to apply.
What communities are eligible? Any community that
has an underserved medical
need is eligible to apply.
How do Communities
and Physicians apply? The
community and the physician must apply jointly.
Applications are due March 31,
2008. The Rural Medical Practice
Board will process all applications
and determine who will be admitted to the program.
Please visit http://www.uams.
additional information and applications. You may also contact
the Rural Programs Administrator,
Morgan Hogue, at 501-526-4266
or by e-mailing mahogue@uams.
Spring 2008 I Arkansas Hospitals
A d v o c a c y
by Paul Cunningham, Senior Vice President, Arkansas Hospital Association
A Look Back at 2007 Healthcare Legislation
The United States Congress
ended the first half of its 110th
session with a brief but intense
burst of energy focused on healthcare matters. In dramatic fashion, Congress brought its 2007
work to a close on December 19
with an 11th-hour flurry of activity,
passing an abbreviated Medicare
legislative package containing several temporary measures to govern
the program until more permanent
decisions are made later this year.
The President signed the new
Medicare, Medicaid, and SCHIP
Extension Act of 2007 on
December 29.
The Senate ignited the fuse
December 18, giving its nod to a
bill based on, but somewhat different than one that came out of
the House earlier. The House followed suit on the amended bill the
next day. Among other things, the
law sends both sides in the quarrelsome deliberations surrounding
expansion of the State Children’s
Health Insurance Program into
neutral corners by extending
SCHIP through March 31, 2009,
with adequate funding for states
to maintain current enrollment levels.
Hospitals across the country
will again reap dividends from
working together in a united front
through their state and national associations. They faced some
giants and giant odds in the 2007
funding wars, but emerged with
several big wins, including sixmonth extensions of cost-based
outpatient lab services for rural
hospitals of fewer than 50 beds
Spring 2008 I Arkansas Hospitals
and independent labs’ ability to
continue billing Medicare directly
for the technical component of certain physician pathology services
provided to hospitals.
Congress also rejected 0.5 percent cuts in Medicare’s inpatient
and outpatient hospital payment
updates for FY 2008 that were in
the original House version.
The biggest victory may be related to a lengthy fight over the inpatient rehabilitation facility (IRF)
75 percent Rule. The new law permanently sets the IRF compliance
threshold at 60 percent, effective
for cost reporting periods starting
July 1, 2006; allows co-morbid
conditions to count toward the
threshold; and eliminates proposed
cuts to hip and knee replacement
However, to pay for the okay
on those items, it freezes the IRF
market basket update from April
1, 2008, through FY 2009.
Another payment update, this
one for long-term care hospitals
(LTCH), will be frozen for the last
quarter of the 2008 rate year. In
return, the LTCHs get regulatory
relief for three years from the 25
percent Rule governing host-hospital admissions, a limited moratorium on new facilities and beds and
new patient and facility criteria.
Not surprisingly, Congress managed to sidestep for a while longer
the complexities of dealing with
Medicare physician fees. Those
were to have been reduced 10 percent beginning January 1. Instead,
the fees will be raised 0.5 percent,
but only for six months.
In addition, the package
includes a provision that extends
for the same six-month period as
the five percent bonus payments to
physicians practicing in areas with
physician shortages. The physician
quality reporting system is also
extended, and there are some revisions in the Physician Assistance
and Quality Initiative fund.
To help offset costs of many provisions adopted in today’s pay-go
legislative world, the law removes
$1.5 billion from the controversial
Medicare Advantage (MA) stabilization fund in 2012. The fund was
originally established to subsidize
MA plans operating in regions of
the country where Medicare managed care plans were previously
unsuccessful, or not offered.
All things considered, the
Medicare, Medicaid, and SCHIP
Extension Act of 2007 is the
equivalent of an end-of-season
bowl win for America’s hospitals. The temporary arrangements
included in the Act set the stage
for 2008.
Congressional leaders are now
arguing over ways to address
long-term solutions to issues like
solving the physician payment
puzzle, making permanent some
of the Act’s extensions, tackling
the whole-hospital exception to
physician self-referral rules and
extending a current moratorium
preventing CMS from moving forward with new Medicaid rules
that could cost public hospitals
almost $4 billion over five years.
Left as is, the moratorium will
expire in May 2008.
Q u a l i t y
FDA Recalls Contaminated Syringes
The U.S. Food and Drug
Administration (FDA) on January
25 announced a nationwide recall
of heparin and saline flush syringes
made by AM2 PAT Inc.
The FDA said two lots of the
pre-filled syringes have been found
to be contaminated with Serratia
marcescens, a bacterium that can
cause serious injury or death. Some
patients exposed to the recalled
syringes have developed blood
infections, the FDA said.
The agency advised healthcare
facilities and consumers that have
the recalled syringes to stop using
them immediately. Healthcare
facilities should immediately
quarantine the products in their
inventory and return them to the
distributor. Consumers should
return them to wherever they got
them and let their healthcare providers know that they have been
exposed to syringes recalled by
the FDA.
Any adverse reactions to the
products should be reported to
the FDA’s MedWatch Program at
Arkansas Hospital Infection
Committee Meets
During the 2007 legislative session, the Arkansas General Assembly
enacted Act 845, which created
a state Advisory Committee on
Healthcare Associated Infections.
The law, which had the backing of
the Arkansas Hospital Association,
set up a program for hospitals to
voluntarily report their rates for
selected types of infections.
The committee is to assist the
Arkansas Department of Health
(ADH) in developing a methodology for collecting, analyzing, and
disclosing the infection rate data,
and it met for the first time on
Thursday, December 6.
The legislation, sponsored by
State Representatives Johnnie
Roebuck of Arkadelphia and Tracy
Pennartz of Fort Smith, asks hospitals and ambulatory surgery centers
to collect and voluntarily submit
infection rates for coronary artery
bypass surgical site infections, total
hip and knee arthroplasty surgical site infections, knee arthroscopy surgical site infections, hernia
repair surgical site infections, and
central line-associated bloodstream
infections in an intensive care unit.
The committee is charged with
developing a surveillance methodology for infection reporting. It
must submit the methodology to
healthcare facilities on or before
September 1, 2008. The ADH is to
compile the data and issue a report
annually, with the first one being
issued by January 1, 2009. The
infection data will be reported only
in the aggregate.
The 15-member Advisory
Committee includes Dr. Paul
Halverson (ADH), Dr. Terry
Yamauchi (Arkansas Children’s
Hospital), Dr. James Phillips
(ADH), Craig Gilliam (Arkansas
Children’s Hospital), Pamela
Higdem (John L. McClellan
Memorial Veterans Hospital),
Debbie Ledbetter (St. Bernards
Medical Center), John May
(Baptist Health Medical Center),
Dr. Tom Monson (John L.
McClellan Memorial Veterans
Hospital), Monte Wilson (Mercy
Ambulatory Surgery Center),
Tamara Wright (Baptist Health
Medical Center-Heber Springs),
Dr. Malcolm Smith (Physician),
Leah Tooke (Nurse), Dr. Anita
Williams (Consumer) and Juanita
Currie (Consumer).
Report Recommends Broadband Network
A new report from a congressional advisory committee calls for
a national, interoperable broadband network to improve communications between emergency
responders and healthcare facilities. The Federal Communications
Commission panel that developed the report said the network
should be built on standardized
Internet protocols that can rapidly
and securely transmit information,
such as video and graphics, and
recommends Congress establish a
federal interagency committee to
provide consistent federal guidance
and standards to ensure compatible
communications systems.
It also calls for mobile applications to create “virtual hospitals”
at the scene and greater use of telemedicine technologies for both dayto-day and emergency response.
Go to http://energycommerce.
FINAL%20Jan.3.2008.pdf to read
the report.
Spring 2008 I Arkansas Hospitals
Q u A l i t y
Trustees’ responsibilities for Quality
Corporate Responsibility and
Health Care Quality:
A Resource for Health Care Boards of Directors
In the fall, the U.S.
Department of Health and
Human Services Office of
Inspector General (OIG)
and the American Health
(AHLA) jointly published
“Corporate Responsibility
and Health Care Quality:
A Resource for Health Care
Boards of Directors.”
This 11-page paper is the
third in a series of co-sponsored
documents by the OIG and the
AHLA. Trustees who serve on
the governing boards of hospitals and other healthcare organizations have fiduciary duties to
those organizations that include
responsibility for oversight of
quality of care and patient safety.
This paper discusses the
important role of hospital trustees in maintaining and improving
quality and safety at a time when
healthcare quality is emerging
as an enforcement priority for
At a time when the OIG, other
federal agencies and various
state agencies are collaborating
to address quality of care issues,
the paper offers practical assistance for trustees in understanding and fulfilling their responsibilities and ensuring that appropriate compliance mechanisms
are in place to monitor quality
of care and patient safety.
The paper, which includes a
list of 10 questions that trustees
can use to evaluate the hospital’s quality and safety ini40
Spring 2008 I Arkansas Hospitals
tiatives, is available
on the OIG Web site
United States Department of Health and Human Services
Office of Inspector General
American Health Lawyers Association
Arkansas Trustee regional
Meetings Begin in April
Trustee education is very important, but hospital trustees are
very busy people. So, what do you do? In an effort to bring
educational programming to Arkansas hospital trustees, the
Arkansas Association of Hospital Trustees will offer a series of
regional dinner meetings in late April and May. The meetings
will be presented in five areas of the state, making it easier for
busy trustees to attend the meetings and network with other
trustees in the area.
At each location, Elisa White, Arkansas Hospital Association
vice president and general counsel, will discuss the role of hospital trustees in maintaining and improving quality and safety
at a time when healthcare quality is emerging as an enforcement
priority for regulators. To accompany her talk, attendees will
receive a comprehensive packet of information on a variety of
issues targeted specifically for trustees.
Each meeting will begin with a reception at 5:30 p.m., followed by dinner and educational session at the following locations:
April 23 – Batesville
May 6 – El Dorado
May 13 – Hot Springs
May 20 – Stuttgart
May 28 – Fort Smith
Program brochures have been mailed to CEOs and members
of the Arkansas Association of Hospital Trustees. Please call
Beth Ingram at 501-224-7878 for additional information.
Q u a l i t y
Governor Appoints 30-Member
Healthcare Roundtable
Beebe has made appointments to
his 30-member Roundtable on
Healthcare, designed to find new
approaches, ideas and strategies for
improving both health and healthcare for Arkansans.
The Roundtable, which held
its second meeting February 7, is
formed of representatives of business, healthcare, consumers, the
ministry and other entities. It will
meet every other month through
2008 working toward discovering
ways to improve the state’s health
system. This information will be
used as a mechanism to inform
and engage the Arkansas General
Assembly when it convenes in
January 2009 and, potentially, the
congressional delegation.
Leading the Roundtable is
Arkansas Surgeon General Dr. Joe
Thompson. Joining Thompson as
members of the panel are:
Accelerate Arkansas
Sharon Allen, Little Rock,
Arkansas Blue Cross and
Blue Shield
Helen Baldwin, Little Rock,
Arkansas Prostate Cancer
Phil Baldwin, Arkadelphia,
Dr. Jonathan Bates,
Little Rock, Arkansas
Children’s Hospital
Bolden, Jacksonville,
Evangelistic Ministries
Dr. Thomas Bruce, Little Rock,
retired UAMS and Clinton
School dean
Leslie Campbell, Hot Springs,
Golden Ventures
Dr. Jim Citty, Searcy, family
practice physician
Patty Clary, Magnolia, consumer
Larnell Davis, Pine Bluff,
Jefferson Comprehensive
Care System
Linda Dillman, Fayetteville,
Dr. Susan Hanrahan, Jonesboro,
ASU College of Nursing and
Health Professions
Russ Harrington, Little Rock,
Baptist Health
Caryol Hendrix, Hackett,
Employer Health Coalition
Alan Hughes, Little Rock,
Arkansas AFL-CIO
Ray Kordsmeier, Conway,
Conway Regional Health
Dr. Drew Kumpuris, Little
Rock, cardiologist
Mike Malone, Fayetteville,
Northwest Arkansas Council
Pam Marshall, Tontitown, consumer
Joe Meyer, Little Rock, Alltel
Dr. Eddie Ochoa, Little Rock,
Ben Owens, Jonesboro, St.
Bernards Healthcare
Dr. Nick Paslidis, Little Rock,
Arkansas Foundation for
Medical Care
Ray Scott, Little Rock, former director, Department
of Human Services
Sandy Stroope, Harrison,
Harrison Boat World
Robert Taylor, mayor of
Ken Tillman, Searcy, Arkansas
Farm Bureau
The Rev. Guy Whitney, North
Little Rock, First United
Methodist Church
Dr. I. Dodd Wilson, Little
Arkansas for Medical
Financial Incentive Program Guide
The Agency for Healthcare Research
and Quality (AHRQ) has published a
document to guide employers, health
plans and other healthcare purchasers
in using financial incentives to improve
healthcare quality and reduce costs.
The guide includes examples of
financial incentives already being
offered, criteria for selecting performance measures and suggestions for
increasing the likelihood that a consumer will be attracted by the incentives.
The guide includes 21 questions
health insurance purchasers should
take into account when considering
whether to implement an incentives
Click on
value/incentives.htm to review the
Spring 2008 I Arkansas Hospitals
M e d i c A r e / M e d i c A i d
CMs Memo on Interpretive Guidelines
The Centers for Medicare and
Medicaid Services (CMS) issued a
memorandum to its State Survey
Agency Directors on the use of
Interpretive Guidance by surveyors for long-term care facilities.
In a footnote, CMS states that
“[a]lthough surveyors must use
the information in Guidelines,
they must be cautious in their
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Read the memo at
downloads/ SCLetter08-10.pd
Proposed rule for LTCHs
The Centers for Medicare
& Medicaid Services issued a
January 24 proposed rule providing a 2.6 percent increase in
Medicare prospective payment
rates for long-term care hospitals
(LTCH) in rate year 2009. The
rule proposes a 2009 standard
rate of $39,076.28, which reflects
a full 3.5 percent market basket
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with the req
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update adjusted by a congressionally mandated market basket
freeze for one quarter in 2008 and
a 0.9 percent reduction in 2009 to
offset coding behavior in 2006.
The agency proposes to return
the effective date for the LTCH
annual update to October 1 from
July 1, which would make the
2009 rate effective for a 15-month
period from July 1, 2008, through
September 30, 2009.
CMS estimates total Medicare
payments to LTCHs would
increase by $124 million in 2009
to about $4.44 billion. The agency expects to implement other
LTCH provisions found in the
2007 Medicare Extension Act in
a future rule.
“Freestanding” Emergency
Department Requirements
Spring 2008 I Arkansas Hospitals
In response to “increasing
interest” in provider-based,
off-campus emergency departments and hospitals that specialize in the provision of
emergency services, CMS
recently issued a memorandum to its State Survey
Agency Directors offering
guidance on the applicable
regulatory standards that
govern the circumstances under
which these “freestanding” emergency departments meet the CMS
Conditions of Participation that
qualify them to participate in
Medicare as a hospital, or part of
a hospital.
See the memorandum at http://
w w w. c m s . h h s . g o v / s u r v e y c e rtificationgeninfo/downloads/
M e d i c a r e / M e d i c a i d
CMS Amends RAC Program Schedule
The Centers for Medicare
& Medicaid Services (CMS)
has amended the Proposed
Statement of Work (SOW) for
the Recovery Audit Contractor
(RAC) program, significantly
changing its implementation
schedule. The November 7,
2007, Statement of Work is
available for viewing, along
with the new implementation
map at http://www.cms.hhs.
While the American Hospital
Association and the Arkansas
Hospital Association are carefully analyzing the changes in the
amended SOW, initial review found
several positive changes, including:
• An extended rollout schedule
with different states coming under
review in March 2008, October
2008 and January 2009.
• No claims with dates of service
prior to October 1, 2007, will be
•Hospital- and provider-specific medical record request
limits will be set by CMS.
The Arkansas Hospital
Association continues to offer
workshops and Webinars on
the RAC program to help
member hospitals understand
the implications the program
will have on Medicare reimbursements and day-to-day
operations. On April 5, the
AHA will offer a Webinar
about the program. In addition, the April 22 Compliance
Forum will feature a very candid discussion of the RAC program by
James Kopf, president of Healthcare
Oversight, Inc. For program details,
please see
Arkansas Medicaid Outpatient Rate Update
The Arkansas Medicaid program
posted a December 26 public notice
regarding its proposed increase for
hospital outpatient rates. The proposal would raise by 58 percent Medicaid
payments for drugs/injections, emergency room care, outpatient assessments, non-emergency room outpatient visits, emergency outpatient hospital supplies, treatment/observation
room fees for hospital outpatient services and four categories of outpatient
surgical services.
The increase was determined after
a Medicaid review of (1) the hospital/medical inflationary cost increase
index changes between July 1, 1992
(the last time that Medicaid outpatient rates were changed by an acrossthe-board reduction), and January
1, 2008, and (2) the most recent
Arkansas Hospital Association analysis of Medicaid hospital outpatient
Medicaid also plans to increase
the rates for hospital outpatient
laboratory, X-ray and other tests to
100 percent of the current physician
Medicaid maximum. The proposed
rate increases are subject to legislative review and must be approved by
the federal Centers for Medicare &
Medicaid Services (CMS).
Once all approvals are secured,
the new rates will have a January 1,
2008, effective date.
Medicare Spending Tops $400 Billion
18.7 percent to $401.3 billion
in 2006, as prescription drug
spending shifted to Medicare
from Medicaid and private coverage, the Centers for Medicare
& Medicaid Services reported in
That’s the largest annual
increase in Medicare spending
since 1981 and twice the growth
seen in 2005.
Total U.S. spending for hospital
care grew 7.0 percent in 2006 to
$648.2 billion, down from a 7.3
percent increase in 2005, as growth
in the underlying cost of hospital
services slowed to 4.1 percent from
4.3 percent, CMS said.
Spending for physician and
clinical services grew 5.9 percent
in 2006 to $447.6 billion. That’s
down from 7.4 percent in 2005,
due in part to a freeze in Medicare
payments. The report appeared
in the January/February issue of
Health Affairs.
Spring 2008 I Arkansas Hospitals
M e d i c A r e / M e d i c A i d
CMS Revamping Regional Offices
On December 28, 2007, CMS
published a notice in the Federal
Register summarizing a recent
regional reorganization under which
Regional Office (RO) organizational codes have been abolished, but
the Regional Offices themselves are
Association has learned that services which the ROs provide to
Medicare beneficiaries, Medicaid
recipients and other stakeholders
will continue to come from the same
10 ROs. However, those services are
now to be provided under a new
model designed to provide for four
Consortium Administrators who
would manage specific CMS functions in the field as follows:
• The Consortium for Medicare
Health Plans Operations
• The Consortium for Financial
Management and Fee for Service
• The Consortium for Medicaid and
Children’s Health Operations
• The Consortium for Quality
Improvement and Survey and
Certification Operations
The Regional Administrators
(RA) in the remaining six offices
will have the core responsibility
of leading outreach efforts in the
following geographic areas: Boston
RA (Boston and New York),
Atlanta RA (Atlanta and Dallas),
San Francisco RA (San Francisco),
Seattle RA (Seattle and Chicago),
Philadelphia RA (Philadelphia) and
Denver RA (Denver and Kansas
CAHs Allowed OPPs reporting Participation
The Centers for Medicare &
Medicaid Services (CMS) has
reversed a previously stated policy
and now will allow critical access
hospitals (CAH) to submit and
publicly report outpatient quality
data along with other hospitals.
Association (AHA) pushed for this
change after many CAHs nationwide indicated a desire to participate in the program, despite being
exempt from the Medicare outpaary
tient hospital prospective payment
system (OPPS).
More information will be available from CMS later this year,
including when CAHs can begin
reporting data. Hospitals participating in Medicare’s OPPS are
required to submit data on seven
outpatient quality measures to
receive a full payment update in
FY 2008.
The Florida Medicare Quality
Improvement Organization, which
has been selected as the national
program contractor for the outpatient reporting program originally
said that CAHs, which do not participate in the OPPS because they
receive cost-based reimbursement,
would not be allowed to submit
the outpatient measures. However,
AHA urged CMS to let the small
hospitals participate in the quality
reporting because of their commitment to public transparency and
quality improvement.
Guide for Medicare
Code Editor
are Code
Spring 2008 I Arkansas Hospitals
CMS has published
a user’s guide for the
Medicare Code Editor,
which detects and reports
errors in coding claims
data. The guide, effective through September
2008, contains a description of
each coding edit with corresponding ICD-9-CM code lists. The
70-page guide is available online
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Experts in Financial Health
The public finance experts at Crews & Associates
enjoy a rich tradition of helping healthcare
organizations throughout Arkansas. By tailoring
innovative financial solutions designed just for you,
we take pride in helping you deliver quality care.
Contact Paul Phillips today at 501.978.6309
or 800.766.2000 and let our own team of healthcare
experts prescribe the financial cure for your organization.
9th Statement
of Work
QIOs’ Focus
Centers for Medicare &
Medicaid Services (CMS)
announced on February 5
its new statement of work
(SOW) for Medicare’s 53 quality improvement organizations (QIO). The work plan,
which is effective August 1,
incorporates recent recommendations by the Institute
of Medicine and Government
Accountability Office that
QIOs focus more on protecting Medicare patients, patient
care transitions, patient safety
and prevention.
The quality organizations
will be required to provide
direct quality improvement
support to nursing homes, hospitals and physician offices; use
standardized tools; and meet
periodic milestones to maintain
their contracts.
can be found on the CMS
Web site at http://www.
New Hospital Construction • Medical Equipment Purchases/Leases
Healthcare Refinancings
Spring 2008 I Arkansas Hospitals
M e d i c a r e / M e d i c a i d
Arkansas Medicaid Fixing EOB Problem
State Medicaid program officials have informed the Arkansas
Hospital Association that its
claims processing system has been
assigning a Medicaid Explanation
of Benefit (EOB) code 942 as a
beneficiary responsibility, meaning that the provider can attempt
collection of the amount from the
The error has occurred for several years but was only discovered recently, after a Medicaid
recipient pointed it out. EOB code
942 states “injection requires specific diagnosis code.” It implies the
beneficiary would have Medicaid
specific coverage knowledge.
Medicaid now believes that
assigning the responsibility to the
patient was an error, and it should
have been assigned as a provider
responsibility. Steps are now being
taken to make the correction.
Value Based Purchasing Report Issued
Secretary of Health and Human
Services Michael Leavitt has delivered to Congress his Report on
the Medicare Hospital Value-Based
Purchasing Program (VBP), suggesting ways for implementing a
value-based purchasing program for
hospitals under the Medicare inpatient prospective payment system
beginning in fiscal year 2009. The
plan was required by the Deficit
Reduction Act of 2005.
Centers for Medicare &
Medicaid Services’ (CMS) Acting
Administrator Kerry Weems said,
“The agency’s proposal builds on
Medicare’s current pay-for-reporting program, which was originally
implemented in 2005.” That program requires hospitals to report
on specific inpatient quality measures to receive a full IPPS payment
Now, CMS wants to include
financial incentives for better per-
formance. According to CMS, under
the VBP program, a percentage of a
hospital’s base operating payment
for each discharge or DRG payment
would be contingent
on the hospital’s
actual performance
on a specific set of
The transition
from pay-for-reporting to an incentive
based completely on
performance would
occur over a threeyear period.
Public reporting of quality measures on Medicare’s
Hospital Compare
site, a key component
Reporting Hospital
Quality program,
would remain an
essential component of VBP. To
view the entire press release, go
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Spring 2008 I Arkansas Hospitals
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